Podcasts about CSF

Join Jay Gunkelman, QEEGD (the man who has read over 500,000 brain scans), Dr. Mari Swingle (author of i-Minds), and host Pete Jansons for one of the most entertaining and eye-opening episodes of the NeuroNoodle Neurofeedback Podcast to date. This week's guest is David Siever, founder of Mind Alive and creator of the DAVID Premier device — a revolutionary audiovisual entrainment tool designed to combat brain fog, burnout, and post-COVID crashes. From pirate anthems to cutting-edge neuroscience, we explore cerebral spinal fluid, mood recovery, detoxification, and why traditional sleep aids may be making things worse. Packed with science, storytelling, and a few sea shanties, this is an episode you don't want to miss.Topics Discussed

In this feature episode of The Sportsmen's Voice, host Fred Bird sits down with Mark Damian Duda, founder and executive director of Responsive Management, to reflect on a recent New England turkey hunt the two shared and dive deep into the human dimensions of wildlife conservation. They explore the vital role that hunters play in conservation funding, the public's changing attitudes toward hunting, and how research-based communication strategies can shift perceptions and build stronger public support. From demographic trends to the importance of wildlife councils, this episode is a must-listen for anyone passionate about the future of hunting and conservation in America. Whether you're a seasoned outdoorsman, a wildlife advocate, or simply curious about how legal, regulated hunting contributes to conservation, this conversation delivers valuable insight backed by decades of public opinion research. Key Takeaways: Understanding Non-Hunter Perspectives: How have demographic shifts in the United States affected how people view the natural world and our place in it? Find out about Mark's groundbreaking research. Public Support Of Hunting: Has it declined? What steps can hunters and sportsmen and women take to recover the public perception of their lifestyle? Mark answers this and more. Responsive Management's Research: Mark dives into the power of Responsive Management's research in shaping effective outreach strategies, how demographic shifts are reshaping the future of hunting, why positive messaging and respectful language (e.g. "legal, regulated hunting") resonate more with the public, and more. Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode of the Sportsmen's Voice Roundup, Fred Bird and Chris Horton kick off with our lead story discussing the introduction of the Sporting Goods Excise Tax Modernization Act in the Senate and how this bipartisan bill stands to combat tax and conservation funding avoidance. They then tackle an update on the Rigs to Reef legislation, new legislation out of North Dakota's recent legislative session, enhancements to Alaska's Big Game Commercial Services Board, the Fix Our Forest Act aimed at wildfire risk reduction, and efforts to expand Sunday hunting opportunities in Connecticut. Takeaways The Sporting Goods Excise Tax Modernization Act: This legislation is crucial for conservation funding, by closing loopholes exploited by foreign manufacturers to get around the North American Model. North Dakota Senate Bill 2137: This North Dakota bill, which has been passed and signed into law, prohibits NDGFD from enacting or implementing policies related to baiting or supplemental feeding for hunting big game animals on private property.  Alaska Big Game Service Board: Alaska's Big Game Commercial Services Board is being enhanced - look for more in a future episode with Marie Neumiller on that one!   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode of the Sportsmen's Voice Roundup, Fred tackles it solo, covering all the news that's fit to print concerning the outdoor community around the country including legislation aimed at enhancing access to public lands, paint balling bears in California (you read that right), voter registration initiatives for sportsmen in Michigan, advancements in muzzleloading technology in Louisiana, and an update to draconian knife legislation in Delaware.  Takeaways The America The Beautiful Act: Our lead story from Taylor Schmitz relays how this key legislation aims to restore public land infrastructure. California's Bear Boom: California's bear population has grown due to hunting restrictions, while Fred covers some… interesting… ideas from anti-hunters on how to manage bears including throwing pinecones and shooting them with paintball guns. Delaware Knife Law Update: CSF supports a fix to Delaware's knife laws repealing the ban on so-called “switch blade” assisted opening knives, paving the way for another useful tool in sportsmen's gear bag in the state.   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

 In this week's feature episode of The Sportsmen's Voice Podcast, host Fred Bird sits down with Angi Bruce, the first female director of the Wyoming Game and Fish Department, to talk about the evolving challenges and opportunities in wildlife management in the Cowboy State. From emerging legislation and the push for science-based policy to the tension between resident and non-resident hunters, Angi provides a candid look at how Wyoming balances conservation, tourism, and access to public lands. This episode unpacks the realities of conservation funding, the role of hunters in protecting wildlife, and why community engagement and bipartisan support are essential to the future of Wyoming's outdoor heritage. Key Takeaways: Learn About Director Angie Bruce: Dive into Angi's historic role as the first female director of Wyoming Game and Fish The Push For Science-Based Management: Answering why wildlife management should be science-led, not politically driven Wyoming Conservation Funding: Discover how hunting and fishing licenses fund 100% of the agency Residents VS Non-Residents: Explore the growing anti-non-resident sentiment—and what's behind it Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode of the Sportsmen's Voice roundup, Fred is joined by CSF's Senior Coordinator of Southeastern States Conner Barker for this week's lead story on the ongoing debate surrounding Sunday hunting restrictions in North Carolina. Conner and Fred dive into the historical context, recent legislative changes, and the implications of recent court rulings on the future of the policy, along with the impact of these restrictions on hunters and the broader conservation community. Fred then dives into all the rest of the key headlines affecting sportsmen and women around the country, including recent legislative changes affecting wildlife management in North Dakota, the ongoing scrutiny of lead ammunition in the Northeast, and the celebration of Sportsmen's Day in Colorado. Takeaways North Carolina Sunday Hunting: North Carolina has restrictive Sunday hunting laws dating back over a century, and has recently seen legislative and rule making changes opening up Sunday hunting on private lands and 51 game lands. North Dakota Wildlife Agency Authority: CSF believes wildlife management should remain with state agencies for effective conservation; unfortunately recent legislation has now stripped some management authority from the North Dakota Game and Fish Department.   Lead Ammo In The Northeast: CSF opposes statutory bans on using lead ammunition that would have unintended and negative impacts on conservation funding, to the detriment of habitat and wildlife conservation efforts.   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

Papilledema describes optic disc swelling (usually bilateral) arising from raised intracranial pressure. Due to its serious nature, there is a fear of underdiagnosis; hence, one major stumbling points is correct identification, which typically requires a thorough ocular examination including visual field testing. In this episode, Kait Nevel, MD speaks with Susan P. Mollan, MBChB, PhD, FRCOphth, author of the article “Papilledema” in the Continuum® April 2025 Neuro-ophthalmology issue. Dr. Nevel is a Continuum® Audio interviewer and a neurologist and neuro-oncologist at Indiana University School of Medicine in Indianapolis, Indiana. Dr. Mollan is a professor and neuro-ophthalmology consultant at University Hospitals Birmingham in Birmingham, United Kingdom. Additional Resources Read the article: Papilledema Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @IUneurodocmom Guest: @DrMollan Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Nevel: Hello, this is Dr Kait Nevel. Today I'm interviewing Dr Susan Mollan about her article Papilledema Diagnosis and Management, which appears in the April 2025 Continuum issue on neuro-ophthalmology. Susie, welcome to the podcast, and please introduce yourself to our audience. Dr Mollan: Thank you so much, Kait. It's a pleasure to be here today. I'm Susie Mollan, I'm a consultant neuro-ophthalmologist, and I work at University Hospitals Birmingham- and that's in England. Dr Nevel: Wonderful. So glad to be talking to you today about your article. To start us off, can you please share with us what you think is the most important takeaway from your article for the practicing neurologist? Dr Mollan: I think really the most important thing is about examining the fundus and actually trying to visualize the optic nerves. Because as neurologists, you're really acutely trained in examining the cranial nerves, and often people shy away from looking at the eyes. And it can give people such confidence when they're able to really work out straightaway whether there's going to be a problem or there's not going to be a problem with papilledema. And I guess maybe a little bit later on we can talk about the article and tips and tricks for looking at the fundus. But I think that would be my most important thing to take away. Dr Nevel: I'm so glad that you started with that because, you know, that's something that I find with trainees in general, that they often find one of the more daunting or challenging aspects of learning, really, how to do an excellent neurological exam is examining the fundus and feeling confident in diagnosing papilledema. What kind of advice do you give to trainees learning this skill? Dr Mollan: So, it really is practice and always carrying your ophthalmoscope with you. There's lots of different devices that people can choose to buy. But really, if you have a direct ophthalmoscope, get it out in the ward, get it out in clinic. Look at those patients that you'd know have alternative diagnosis, but it gives you that practice. I also invite everybody to come to the eye clinic because we have dilated patients there all the time. We have diabetic retinopathy clinics, and it makes it really easy to start to acquire those skills because I think it's very tricky, because you're getting a highly magnified view of the optic nerve and you've got to sort out in your head what you're actually looking at. I think it's practice. and then use every opportunity to really look at the fundus, and then ask your ophthalmology colleagues whether you can go to clinic. Dr Nevel: Wonderful advice. What do you think is most challenging about the evaluation of papilledema and why? Dr Mollan: I think there are many different aspects that are challenging, and these patients come from lots of different areas. They can come from the family doctor, they can come from an optician or another specialist. A lot of them can have headache. And, as you know, headache is almost ubiquitous in the population. So, trying to pull out the sort of salient symptoms that can go across so many different conditions. There's nothing that's pathognomonic for papilledema other than looking at the optic nerves. So, I think it's difficult because the presentation can be difficult. The actual history can be challenging. There are those rare patients that don't have headache, don't have pulsatile tinnitus, but can still have papilledema. So, I think it- the most challenging thing is actually confirming papilledema. And if you're not able to confirm it, getting that person to somebody who's able to help and confirm or refute papilledema is the most important thing. Dr Nevel: Yeah, right. Because you talk in your article the importance of distinguishing between papilledema and some other diagnoses that can look like papilledema but aren't papilledema. Can you talk about that a little bit? Dr Mollan: Absolutely. I think in the article it's quite nice because we were able to spend a bit of time on a big table going through all the pseudopapilledema diagnoses. So that includes people with shortsightedness, longsightedness, people with optic nerve head drusen. And we've been very fortunate in ophthalmology that we now have 3D imaging of the optic nerve. So, it makes it quite clear to us, when it's pseudopapilledema, it's almost unfair when you're using the direct ophthalmoscope that you don't get a cross sectional image through that optic nerve. So, I'd really sort of recommend people to delve into the article and look at that table because it nicely picks out how you could pick up pseudopapilledema versus papilledema. Dr Nevel: Perfect. In your article, you also talk about what's important to think about in terms of causes of papilledema and what to evaluate for. Can you tell us, you know, when you see someone who you diagnose with papilledema, what do you kind of run through in terms of diagnostic tests and things that you want to make sure you're evaluating for or not missing? Dr Mollan: Yeah. So, I think the first thing is, is once it's confirmed, is making sure it's isolated or whether there's any additional cranial nerve palsies. So that might be particularly important in terms of double vision and a sixth nerve palsy, but also not forgetting things like corneal sensation in the rest of the cranial nerves. I then make sure that we have a blood pressure. And that sounds a bit ridiculous in this day and age because everybody should have a blood pressure coming to clinic or into the emergency room. But sometimes it's overlooked in the panic of thinking, gosh, I need to investigate this person. And if you find that somebody does have malignant hypertension, often what we do is we kind of stop the investigational pathway and go down the route of getting the medics involved to help with lowering the blood pressure to a safe level. I would then always think about my next thing in terms of taking some bloods. I like to rule out anemia because anemia can coexist in a lot of different conditions of raised endocranial pressure. And so, taking some simple blood such as a complete blood count, checking the kidney function, I think is important in that investigational pathway. But you're not really going to stop there. You're going to move on to neuroimaging. It doesn't really matter what you do, whether you do a CT or an MRI, it's just getting that imaging pretty much on the same day as you see the patient. And the key point to that imaging is to do venography. And you want to rule out a venous sinus thrombosis cause that's the one thing that is really going to cause the patient a lot of morbidity. Once your neuroimaging is secure and you're happy, there's no structural lesion or a thrombosis, it's then reviewing that imaging to make sure it's safe to proceed with lumbar puncture. And so, we would recommend the lumbar puncture in the left lateral decubitus position and allowing the patient to be as calm and relaxed as possible to be able to get that accurate opening pressure. Once we get that, we can send the CSF for contents, looking for- making sure they don't have any signs of meningitis or raised protein. And then, really, we're at that point of saying, you know, we should have a secure diagnosis, whether it would be a structural lesion, venous sinus thrombosis, or idiopathic intracranial hypertension. Dr Nevel: Wonderful. Thank you for that really nice overview and, kind of, diagnostic pathway and stepwise thought process in the evaluations that we do. There are several different treatments for papilledema that you go through in your article, ranging from surgical to medication options. When we're taking care of an individual patient, what factors do you use to help guide you in this decision-making process of what treatment is best for the patient and how urgent treatment is? Dr Mollan: I think that's a really important question because there's two things to consider here. One is, what is the underlying diagnosis? Which, hopefully, through the investigational save, you'll have been able to achieve a secure diagnosis. But going along that investigational pathway, which determines the urgency of treatment, is, what's happening with the vision? If we have somebody where we're noting that the vision is affected- and normally it's actually through a formal visual field. And that's really challenging for lots of people to get in the emergency situation because syndromes of raised endocranial pressure often don't cause problems with the visual acuity or the color vision until it's very late. And also, you won't necessarily get a relative afferent papillary defect because often it's bilateral. So I really worry if any of those signs are there in somebody that may have papilledema. And so, a lot rests on that visual field. Now, we're quite good at doing confrontational visual fields, but I would say that most neurologists should be carrying pins to be able to look at the visual fields rather than just pointing fingers and quadrants if you're not able to get a formal visual field early. It's from that I would then determine if the vision is affected, I need to step up what I'm going to do. So, I think the sort of next thing to think about is that sort of vision. So, if we have somebody who, you know, you define as have severe sight loss at the point that you're going through this investigational pathway, you need to get an ophthalmologist or a neuro-ophthalmologist on board to help discuss either the surgery teams as to whether you need to be heading towards an intervention. And there are a number of different types of intervention. And the reason why we discuss it in the article---and we'll also be discussing it in a future issue of Continuum---is there's not high-class evidence to suggest one surgery over another surgery. We may touch on this later. So, we've got our patients with severe visual loss who we need to do something immediately. We may have people where the papilledema is moderate, but the vision isn't particularly affected. They may just have an enlarged blind spot. For those patients, I think we definitely need to be thinking about medical therapy and talking to them about what the underlying cause is. And the commonest medicine to use for raised endocranial pressure in this setting is acetazolamide, a carbonic anhydrous inhibitor. And I think that should be started at the point that you believe somebody has moderate papilledema, with a lot of discussion around the side effects of the medicine that we go into the article and also the fact that a lot of our patients find acetazolamide in an escalating dose challenging. There are some patients with very mild papilledema and no visual change where I might say, hey, I don't think we need to start treatment immediately, but you need to see somebody who understands your disease to talk to you about what's going on. And generally, I would try and get somebody out of the emergency investigational pathway and into a formal clinic as soon as possible. Dr Nevel: Thank you so much for that. One thing that I was wondering that we see clinically is you get a consult for a patient, maybe, who had an isolated episode of vertigo, back to their normal self, completely resolved… but incidentally, somebody ordered an MRI. And that MRI, in the report, it says partially empty sella, slight flattening of the posterior globe, concerns for increased intracranial pressure. What should we be doing with these patients who, you know, normal neurological exam, maybe we can't detect any definite papilledema on our endoscopic exam. What do you think the appropriate pathway is for those patients? Dr Mollan: I think it's really important. The more neuroimaging that we're doing, we're sort of seeing more people with signs that are we don't believe are normal. So, you've mentioned a few, the sort of partially empty sella, empty sella, tortuosity of the optic nerves, flattening of the globes, changes in transverse sinus. And we have quite a nice, again, table in the article that talks about these signs. But they have really low sensitivity for a diagnosis of raised endocranial pressure and isolation. And so, I think it's about understanding the context of which the neuroimaging has been taken, taking a history and going back and visiting that to make sure that they don't have escalating headache. And also, as you said, rechecking the eye nerves to make sure there's no papilledema. I think if you have a good examination with the direct ophthalmoscope and you determine that there's no papilledema, I would be confident to say there's no papilledema. So, I don't think they need to necessarily cry doubt. The ophthalmology offices, we certainly are having quite a few additional referrals, particularly for this, which we kind of called IIH-RAD, where patients are coming to us for this exclusion. And I think, in the intervening time, patients can get very anxious about having a sort of MRI artifact picked up that may necessarily mean a different diagnosis. So, I guess it's a little bit about reassurance, making sure we've taken the appropriate history and performed the examination. And then knowing that actually it's really a number of different signs that you need to be able to confidently diagnose raised ICP, and also the understanding that sometimes when people have these signs, if the ICP reduces, those signs remain. You know, we're learning an awful lot more about MRI imaging and what's normal, what's within normal limits. So, I think reassurance and sensible medical approach. Dr Nevel: Absolutely. In the section in your article on idiopathic intracranial hypertension, you spend a little bit of time talking about how important it is that we sensitively approach the topic of potential weight loss for those patients who are overweight. How do you approach that discussion in your clinic? Because I think it's an important part of the holistic patient care with that condition. Dr Mollan: I think this is one of the things that we've really listened to the patients about over the last number of years where we recognize that in an emergency situation, sometimes we can be quite quick to sort of say, hey, you have idiopathic endocranial hypertension and weight loss is, you know, the best treatment for the condition. And I think in those circumstances, it can be quite distressing to the patient because they feel that there's a lot of stigma attached around weight management. So, we worked with the patient group here at IIH UK to really come up with a way of a signposting to our patients that we have to be honest that there is a link, you know, a strong evidence that weight gain and body shape change can cause someone to fall into a diagnosis of IIH. And we know that weight loss is really effective with this condition. So, I think where I've learned from the patients is trying to use language that's less stigmatizing. I definitely signpost that I'm going to talk about something sensitive. So, I say I'm going to talk about something sensitive and I'm going to say, do you know that this condition is related to body shape change? And I know that if I listen to this podcast in a couple of years, I'm sure my words will have changed. And I think that's part of the process, is learning how to speak to people in an ever-changing language. And they think that sort of signpost that you're going to talk about something sensitive and you're going to talk about body shape change. And then follow up with, are you OK with me talking about this now? Is it something you want to talk about? And the vast majority of people say, yes, let's talk about it. There'll be a few people that don't want to talk about it. And I usually come in quite quickly, say, is it OK if I mention it at the next consultation? Because we have a duty of care to sort of inform our patients, but at the same time we need to take them on that journey to get them back to health, and they need to be really enlisted in that process. Dr Nevel: Yeah, I really appreciate that. These can be really difficult conversations and uncomfortable conversations to have that are really important. And you're right, we have a duty as medical providers to have these conversations or inform our patients, but the way that we approach it can really impact the way patients perceive not only their diagnosis, but the relationship that we have with our patients. And we always want that to be a positive relationship moving forward so that we can best serve our patients. Dr Mollan: I think the other thing as well is making sure that you've got good signposts to the professionals. And that's what I say, because people then say to me, well, you know, kind of what diet should I be on? What should I be doing? And I say, well, actually, I don't have professional experience with that. I'm, I'm very fortunate in my hospital, I'm able to send patients to the endocrine weight management service. I'm also able to send patients to the dietetic service. So, it's finding, really, what suits the patient. Also what's within licensing in your healthcare system to be able to provide. But not being too prescriptive, because when you spend time with weight management professionals, they'll tell you lots of different things about diets that people have championed and actually, in randomized controlled trials, they haven't been effective. I think it's that signpost really. Dr Nevel: Yeah, absolutely. So, could you talk a little bit about what's going on in research in papilledema or in this area, and what do you think is up-and-coming? Dr Mollan: I think there's so much going on. Mainly there's two parts of it. One is image analysis, and we've had some really fantastic work out of the Singapore group Bonsai looking at a machine learning decision support tool. When people take fundal pictures from a normal fundus camera, they're able to say with good certainty, is this papilledema, is this not papilledema? But more importantly, if you talk to the investigators, something that we can't tell when we look in is they're able to, with quite a high level of certainty, say, well, this is base occupying lesion, this is a venous sinus thrombosis, and this is IIH. And you know, I've looked at thousands and thousands of people's eyes and that I can't tell why that is. So, I think the area of research that is most exciting, that will help us all, is this idea about decision support tools. Where, in your emergency pathway, you're putting a fundal camera in that helps you be able to run the image, the retina, and also to try and work out possibly what's going on. I think that's where the future will go. I think we've got many sort of regulatory steps and validation and appropriate location of a learning to go on in that area. So, that's one side of the imaging. I think the other side that I'm really excited about, particularly with some of the work that we've been doing in Birmingham, is about treatment. The surgical treatments, as I talked about earlier… really, there's no high-class evidence. There's a number of different groups that have been trying to do randomized trials, looking at stenting versus shunting. They're so difficult to recruit to in terms of trials. And so, looking at other treatments that can reduce intracranial pressure. We published a small phase two study looking at exenatide, which is a glucagon-like peptide receptor agonist, and it showed in a small group of patients living with IIH that it could reduce the intracranial pressure two and a half hours, twenty-four hours, and also out to three months. And the reason why this is exciting is we would have a really good acute therapy---if it's proven in Phase III trials---for other diseases, so, traumatic brain injury where you have problems controlling ICP. And to be able to do that medically would be a huge breakthrough, I think, for patient care. Dr Nevel: Yeah, really exciting. Looking forward to seeing what comes in the future then. Wonderful. Well, thank you so much for chatting with me today about your article. I really enjoyed learning more from you during our conversation today and from your article, which I encourage all of our listeners to please read. Lots of good information in that article. So again, today I've been interviewing Dr Susie Mollan about her article Papilledema Diagnosis and Management, which appears in the most recent issue of Continuum on neuro-ophthalmology.Please be sure to check out Continuum episodes from this and other issues. And thank you to our listeners for joining us today. Thank you, Susie. Dr Mollan: Thank you so much. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

In this episode of the Sportsmen's Voice podcast, Fred covers critical state-level legislative developments that could shape the future of hunting, fishing, and conservation across the country. With updates from Arkansas, Washington, Massachusetts, North Carolina, and South Carolina, this episode gives sportsmen and women around the country the insights they need to stay informed and engaged. Takeaways Arkansas: Tune in for updates on how a successful legislative session brings several pro-sportsmen bills across the finish line, reinforcing hunting and fishing rights. Washington: Recent appointments to the state's Fish and Wildlife Commission aim to restore balance and ensure better representation of sportsmen's interests. Massachusetts: A controversial new bill could restrict hunting and fishing in designated old-growth forest reserves, potentially setting a dangerous precedent for public land access. Sustainable Management: The North American Model of Wildlife Conservation remains the foundation for effective, science-based practices.   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode of The Sportsmen's Voice Podcast, host Fred Bird is joined once again by Senior Director of Fisheries Policy Chris Horton to break down House Bill 443—a game-changing piece of legislation aimed at improving recreational fishing data collection in Georgia. They dive into why federal fishery management systems are falling short, and how state-led efforts can lead to more accurate, real-time data, longer fishing seasons, and better policy decisions for anglers. The conversation covers everything from slot limits and discard mortality to the impact of artificial reefs and post-release mortality rates. If you care about sustainable fishing, angler rights, and better fishing seasons, this episode is a must-listen. Key Takeaways: House Bill 443: This bill introduces a saltwater fishing license fee to fund improved data collection. All About Data: Federal data collection methods lack the real-time accuracy needed for today's fishery management, while state-level management allows for localized, angler-driven decisions. Accurate angler reporting = longer, better fishing seasons. Poor estimates of fish harvested, as well as those that are released, can cut seasons short. Total mortality: Total mortality includes released fish – a percentage of which are expected to die. High release rates and slot limits can increase discard mortality. Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

 In this week's roundup while Robbie is off galavanting again, Ashlee is joined by Fred Bird of the Congressional Sportsmen's Foundation. And luckily, in addition to being CSF's Senior Manager of Eastern States, Fred also serves as the host of CSF's own Sportsmen's Voice podcast - because when a catastrophic power and internet failure hits Ashlee's office mid-recording, Fred is able to step in and finish the episode! Ashlee and Fred discuss legislative news around the country, including the implications of controversial bills like Alabama's House Bill 509, the significance of food sovereignty legislation such as the statute passed in Maine, legal challenges in Pennsylvania regarding the Open Fields doctrine and wildlife management's ability to enter private land vs the rights of hunting clubs, the legal implications surrounding wildlife & property surveillance, recent legislative updates on the ND Chronic Wasting Disease (CWD) bills, and the outline of the plan for the return of bear hunting in Florida. Check it out! Get to know the guest: https://congressionalsportsmen.org/the-sportsmens-voice-podcast/  https://podfollow.com/1705085498  https://congressionalsportsmen.org/staff/fred-bird/ Do you have questions we can answer? Send it via DM on IG or through email at info@bloodorigins.com Support our Conservation Club Members! Trophy Destinations: https://www.trophydestinations.com/  Sun Africa Safaris: https://www.sun-africa.com/  Bear Country Outdoors: https://bearcountryoutdoors.com/  See more from Blood Origins: https://bit.ly/BloodOrigins_Subscribe Music: Migration by Ian Post (Winter Solstice), licensed through artlist.io This podcast is brought to you by Bushnell, who believes in providing the highest quality, most reliable & affordable outdoor products on the market. Your performance is their passion. https://www.bushnell.com  This podcast is also brought to you by Silencer Central, who believes in making buying a silencer simple and they handle the paperwork for you. Shop the largest silencer dealer in the world. Get started today! https://www.silencercentral.com  This podcast is brought to you by Safari Specialty Importers. Why do serious hunters use Safari Specialty Importers? Because getting your trophies home to you is all they do. Find our more at: https://safarispecialtyimporters.com  Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode of the Sportsmen's Voice podcast, Fred Bird and CSF's Assistant Manager for the Southwestern States Barry Snell, discuss two Arizona bills aimed at protecting Second Amendment rights, prohibiting Merchant Category Coding and Firearms Preemption. The conversation then shifts to the controversial hounding petition in Arizona. The two exploring the implications of and the potential consequences of banning hound hunting, highlighting the importance of community engagement in wildlife management and the challenges posed by urban perspectives on rural wildlife issues. Fred then covers the rest of the news around the nation important to sportsmen, including the management of coyote populations in Michigan, the significance of public access to waterways in West Virginia, the need for effective forest management to prevent wildfires, and the establishment of collegiate coalitions to engage youth in conservation efforts.  Takeaways Pro Gun Legislation Advancing In Arizona: Arizona is advancing firearm legislation to protect Second Amendment rights, where merchant category codes could infringe on financial privacy for all consumers and civil penalties for government officials may deter restrictive local gun laws. Hound Hunting Ban Petition Circulating In Arizona: The hounding petition in Arizona seeks to ban all hound hunting. Meanwhile, a similar California ban on hounding has led to increased wildlife-human conflicts. Michigan Coyotes: Michigan is looking at a year-round season for coyote hunting after the Commission voted to shorten the season last year, excluding Mid-April through Mid-July. Coyote hunting and management is crucial for ecological balance in Michigan and beyond. Public Access To Public Waterways: Public access to waterways is essential for conservation funding as a lynchpin for many recreational activities.   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

In this week's episode of The Sportsmen's Voice Roundup, Fred covers all the news fit to print about the world of hunting, fishing and shooting policy including the 75th anniversary of the Sport Fishing Restoration Act, a deep dive into the American System of Conservation Funding, and recent legislative developments in Maine, Oregon, Minnesota, and Georgia, along with emphasizing the importance of self-funding conservation programs and the role of sportsmen and women in wildlife management.    Takeaways Sport Fish Restoration Act: This important Act has been crucial for aquatic resource conservation for 75 years. Firearm Transfer Waiting Period In Maine: CSF is working hard on repealing a 72-hour waiting period for firearm transfers. Crossbows In Minnesota: Crossbows are being fully included in Minnesota's archery season, in a big win for accessibility for hunters.   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

Attention radiologists: Were you trained to look for Tarlov cysts when reading spine MRI? In this episode of Backtable MSK, interventional neuroradiologist Dr. Kieran Murphy joins the studio to discuss the serious issue of chronic pain related to Tarlov cysts, a condition often overlooked in both diagnosis and treatment. Tarlov cysts, also known as perineural cysts, are fluid-filled sacs that form due to the dilation of the subarachnoid space around spinal nerve roots, most commonly at the base of the spine. --- SYNPOSIS Dr. Murphy highlights the high risk of depression and suicide among patients, who are often misdiagnosed and overprescribed ineffective pain medications. He explains how to identify and treat Tarlov cysts through aspiration and fibrin sealing, addresses the historical dismissal of their significance, and underscores the need for a better understanding of CSF leaks. Additionally, Dr. Murphy emphasizes the importance of institutional responsibility in occupational radiation safety for interventionalists, advocating for improved lead protection and antioxidant use to mitigate radiation damage. The episode concludes with a humbling reminder of the implicit biases present in medical practice and the ongoing need for more inclusive and attentive patient care. --- TIMESTAMPS 00:00 - Introduction 01:24 - Challenges in Diagnosing and Treating Tarlov Cysts 04:05 - Patient Experiences and Misdiagnoses 06:06 - Cyst Aspiration Techniques 15:12 - Improved Diagnosis of CSF Abnormalities 22:10 - Allergic Reactions to Fibrin 25:30 - Implicit Bias in Medicine 34:50 - Radiation Safety in Radiology 43:47 - Final Thoughts and Reflections

Today we discuss: Cerebrospinal Fluid (CSF) leaksAgenda:  1. Dr. Cardenas: Tell us your story!  2.     So, what is a CSF leak? a.     What is leaking? From where? Why do leaks happen? b.     Common symptoms? Uncommon symptoms? c.     Why don't more people know about this?  3.     Okay, so let's go back to basic anatomy & let's go from general to specific- talk to us about: a.     connective tissueb.     vasculaturec.     central nervous system flow: CSF, lymph, bloodd.     Relationship with bones like CCI, Eagle's, others?e.     Relationship with the vasculature/ flow in the rest of the body like pelvic venous congestion 4.     How do we evaluate for this?b.     Imagingc.     Blood patches d.     Embolization  5.     How do we TREAT this? a.     Immediate: Blood patches/ embolization/ pressure adjustments (meds, etc) b.     Counter facial strain. What is it & how does it help? Role for other physical tx like PT/ chiro?Bio: Dr Brianna Cardenas is a Physician Assistant, a certified athletic trainer and the founder of Healed and Empowered, an organization that specializes in optimizing health among those living with chronic illness. She has recently joined the team at NeuroVeda Health where she brings 13 years of healthcare experience. She is also a patient living with Ehlers-Danlos Syndrome, an “invisible” condition that can be hard to diagnose and often discounted by healthcare providers as a result. Brianna's lived experience as a patient informs her work as a healthcare provider to others.Bio: Dr. Maxwell is a Board Certified Pediatric Cardiologist and Pediatrician. He received his medical degree from Johns Hopkins Medical School and a Residency in Pediatrics at The University of California at San Francisco followed by clinical and research fellowships in Pediatric Cardiology at Lucile Salter Packard and Stanford Hospitals and Children's Hospital of Philadelphia. His research interests include study of endothelial control of vasomotor tone, nitric oxide, sports cardiology, dysautonomia, hypermobility syndromes, & mast cell activation syndrome and their relationships to environmental toxins. For his research he received an American Heart Association Award for Research in Molecular Biology and was an American College of Cardiology Young Investigator Award finalist. He has published many articles and book chapters on these subjects. For his clinical work, he has been voted by his peers as a Top Doctor in Northern California annually since 2017.Resources/ Links/ Articles: ·       https://www.eds.clinic/articles/spiky-leaky-syndrome·       https://www.medicalandresearch.com/current_issue/1962

In this feature episode of The Sportsmen's Voice, Fred sits down with Steve Smith, Executive Director of Pennsylvania Game Commission, to discuss Sunday hunting in Pennsylvania and the years-long and ongoing push to pass landmark legislation to remove the remaining restrictions. Then, Fred is joined by CSF Vice President of Policy Brent Miller to dive deeper into the the complexities surrounding Sunday hunting legislation across the United States as a whole (a subject Brent actually wrote his thesis on!). They explore the historical context and theories of Sunday hunting bans (hint, it's not what people think), the incremental approach to changing these laws, and the various arguments for and against Sunday hunting, including safety concerns, discrimination against hunters, the opposition from professional guides and landowners, the importance of youth hunting opportunities and the bipartisan efforts to advance hunting rights.  Key Takeaways: Historical Context Is Everything: Discrimination against hunters is evident in Sunday hunting laws. Diving into the history of these bans can reveal the potentially classist, and possibly even racist roots of Sunday hunting bans, while safety concerns regarding hunting on Sundays are largely unfounded. Longstanding Priority In The Keystone State: The push for Sunday hunting has been a long-standing priority for the Pennsylvania Game Commission. Legislative momentum is building, with a majority of hunters now supporting Sunday hunting. Stakeholder Updates: The Farm Bureau's support for Sunday hunting marks a significant shift in stakeholder perspectives, along with the support of hunters themselves  Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

In this week's episode of The Sportsmen's Voice Roundup, Fred is joined by CSF's Mid-Atlantic Assistant Manager, Kaleigh Leager to discuss Virginia Governor Glenn Youngkin's VETO of antigun legislation in the state. Kaleigh and Fred break down the implications of age restrictions on firearm purchases, the ongoing debate surrounding assault weapon legislation, and the importance of retaining young sportsmen and women in the hunting community. Fred also covers a policy briefing on Capitol Hill, updates from South Dakota's legislative session, nominations for the Department of Interior, developments in Nevada's hunting laws, Connecticut's restrictions on Sunday hunting, and the potential for elk hunting in North Carolina. Get all the news fit to print about the great outdoors and the sports we all love right here!   Takeaways Unifying Priorities For Sportsmen And Women: The American Wildlife Conservation Partners (AWCP) sponsored a policy briefing on Capitol Hill focused on unifying priorities for sportsmen and women. Two Anti-Sportsmen's Bills Defeated in South Dakota: CSF, working with partners and the South Dakota Legislative Sportsmen's Caucus, was able to defeat bills that could have led to a transfer of funds from the South Dakota Game, Fish, and Parks and a discharge distance bill that was introduced during the session. Department Of Interior Nominations: The following CSF-supported nominees are working through the confirmation process right now, Brian Nesvik is vying to be the next Director of the US Fish and Wildlife Service, and Catherine MacGregor will serve as the next Deputy Secretary of the Department of the Interior.    Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

For this episode, we discuss the roles and sensitivity of mitochondria with Dr. Richard Frye, MD, PhD. Dr. Frye received an MD and a PhD in Physiology and Biophysics from Georgetown University. He is board certified in Pediatrics, Neurology with special competence in Child Neurology, and as a Certified Principal Investigator. In addition, he has a Masters in Biomedical Sciences and Biostatistics from Drexel University. Dr. Frye has over 300 publications in leading journals and book chapters.Dr. Frye shares many figures during the conversation so the listener can follow along.Dr. Richard Frye https://drfryemdphd.comRossingnol Medical Center Facebook https://www.facebook.com/RossignolMedicalCenterNeurological Health Foundation https://neurologicalhealth.orgHealthy Child Guide https://neurologicalhealth.org/the-guide-5/Daylight Computer Company https://daylightcomputer.com?sca_ref=8231379.3e0N25Wg3wuse "autism" in the discount code for $25 coupon.This is the future of tech.Chroma Light Therapy https://getchroma.co/?ref=autismuse "autism" for a 10% discount,0:00 Dr. Richard Frye0:58 Daylight Computer Company5:17 Chroma Light Devices8:27 History of Leucovorin; low risk, high reward; Folate Receptor Alpha (FRa)10:25 Blood Brain Barrier; Folate; CSF (cerebral spinal fluid)14:04 DNA, RNA; MTHFR (Methylenetetrahydrofolate reductase)17:34 Cerebral Folate deficiency; BH4, Placenta & Womb23:35 Folate deficiency & Autism26:21 Clinical Studies & Data29:28 Folate & Mitochondria; Cerebral Folate Antibodies; White Matter Findings (!)34:45 Cerebral Folate deficiency & Ranges; Autistic Phenotypes: Language, Communication, & Behaviors40:45 Language & Communication; Self-Injurious Behaviors; Hyperactivity, Agitation; Treatment duration42:53 Folate Autoantibodies & Maternal Health & Markers45:30 Studies & Behavioral outcomes; inflammation & thyroid findings46:58 Neural development; Language connections, white matter tracts & distal connections48:53 Leucovorin for different severity/levels of Autism; Spinal Bifida51:08 Preparing for pregnancy53:50 Transgenerational aspects of Folate Autoantibodies Research; Prenatal Care & Awareness59:32 Guidance & SupportX: https://x.com/rps47586Hopp: https://www.hopp.bio/fromthespectrumYT: https://www.youtube.com/channel/UCGxEzLKXkjppo3nqmpXpzuAemail: info.fromthespectrum@gmail.com

In this week's episode of The Sportsmen's Voice Roundup, Fred is joined by CSF's Mid-Atlantic Assistant Manager Kaleigh Leager to discuss the Maryland lead hunting ammunition ban. Kaleigh breaks down the legislative process, the scientific arguments surrounding lead ammunition, and the economic implications for hunters and conservation. Fred also covers recent legislative updates affecting fishing, hunting, and wildlife conservation across various states, including Georgia, Alabama, Nebraska, and Montana. From the passage of House Bill 443 in Georgia aimed at improving fisheries management, to new firearm legislation in Nebraska, habitat improvement projects in Montana, a significant court ruling on corner crossing in Wyoming, and proposed sales tax holidays for firearms in Georgia and Alabama. Get all the news fit to print about the great outdoors and the sports we all love right here!   Takeaways Lead Bans Are Bad Policy For Hunting & Conservation: Maryland's lead hunting ammo ban, aimed at phasing out lead ammunition for all game species, was successfully opposed this year. Due to the nature of specific science to each state, economic impacts and more, a blanket ban on lead ammunition is simply not appropriate. ACTION ALERT: Pennsylvania Sunday Hunting: Kaleigh and Fred break in with an update on ongoing efforts to pass legislation for Sunday hunting in Pennsylvania, discussing the history of Senate Bill 67, the need for modernizing hunting laws, and the role of YOU, as constituents, in influencing legislative outcomes. ACTION ALERT: Georgia House Bill 443: This bill aims to improve fisheries management in Georgia. Corner Crossing Update: We have new clarification of the rules for corner crossing and its implications on access to public lands   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

خلاصه‌ی مقالات جدید: ۱-فاکتورهای آنالیز CSF برای تشخیص مننژیت ۲-اهمیت تست ویروسی مثبت برای روند تشخیصی نوزاد تب‌دار ۳-روش دادن دارو در ایست قلبی خارج از بیمارستان ۴-رابطه‌ی تأخیر شوک در ایست قلبی با موفقیت احیا

In this episode of the Bendy Bodies Podcast, Dr. Linda Bluestein welcomes Dr. Petra Klinge, a renowned neurosurgeon specializing in tethered cord syndrome (TCS), Chiari malformation, and cerebrospinal fluid (CSF) disorders. They dive deep into occult tethered cord syndrome, a condition where MRI scans appear normal, yet patients still experience neurological symptoms, chronic pain, and bladder/bowel dysfunction. Dr. Klinge explains how tethered cord affects EDS patients, the role of connective tissue disorders, and what makes someone a good candidate for surgery. Whether you've been struggling with undiagnosed spinal issues or are considering tethered cord release surgery, this episode is packed with valuable insights and cutting-edge research. Takeaways: Tethered Cord Can Be “Occult” (Hidden on MRI) – Many patients with classic tethered cord symptoms are dismissed because their MRI appears “normal.” A clinical diagnosis is key. EDS Patients Are at Higher Risk – Changes in collagen and the extracellular matrix make individuals with Ehlers-Danlos Syndrome more prone to tethered cord syndrome, which can be congenital or acquired. Tethered Cord Syndrome Affects the Entire Spine – While traditionally thought to impact only the lower body, new research suggests TCS can cause upper body pain, weakness, and neurological dysfunction. Surgery Isn't Always the First Step – Physical therapy, craniosacral therapy, and manual techniques may help some patients, but progressive neurological decline may require surgical release. Retethering is Possible After Surgery – Around 7% of patients may need a second surgery due to scar tissue reattaching the spinal cord, but new surgical techniques are improving long-term outcomes. Articles referenced in the episode: https://pubmed.ncbi.nlm.nih.gov/38489815/ https://pubmed.ncbi.nlm.nih.gov/38202013/ https://pubmed.ncbi.nlm.nih.gov/35307588/ Connect with YOUR Hypermobility Specialist, Dr. Linda Bluestein, MD at https://www.hypermobilitymd.com/. Thank YOU so much for tuning in. We hope you found this episode informative, inspiring, useful, validating, and enjoyable. Join us on the next episode for YOUR time to level up your knowledge about hypermobility disorders and the people who have them. Join YOUR Bendy Bodies community at https://www.bendybodiespodcast.com/. Learn more about Human Content at http://www.human-content.com Podcast Advertising/Business Inquiries: sales@human-content.com YOUR bendy body is our highest priority! Learn about Dr. Petra Klinge Website: https://www.brownhealth.org/providers/petra-m-klinge-md-phd Keep up to date with the HypermobilityMD: YouTube: youtube.com/@bendybodiespodcast Twitter: twitter.com/BluesteinLinda LinkedIn: linkedin.com/in/hypermobilitymd Facebook: facebook.com/BendyBodiesPodcast Blog: hypermobilitymd.com/blog Part of the Human Content Podcast Network Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode of The Sportsmen's Voice, Fred sits down with the federal policy team from the Congressional Sportsmen's Foundation for an in-depth Q1 review of the new administration and Congress. From groundbreaking legislation to exciting conservation wins, this jam-packed conversation is essential listening for sportsmen and women who care about the future of America's outdoor heritage.   Key Topics Covered: Federal Policy Landscape: Fred and Director of Federal Relations Taylor Schmitz break down the latest legislative developments in Washington, D.C. Learn about the bipartisan support behind the Farm Bill and wildlife conservation efforts, as well as the challenges presented by digital markets and foreign manufacturer taxation. Wildlife Conservation: Get insights into the Wildlife Movement Through Partnerships Act, a crucial initiative designed to combat habitat fragmentation and improve wildlife connectivity. Fisheries Policy Updates: Senior Director of Fisheries Policy Chris Horton shares updates on the MAP Waters Act, MAP Oceans Act, and legislative measures tackling shark depredation. Discover how the Sporting Goods Excise Tax Modernization Act and the 75th Anniversary of the Dingle-Johnson Act are shaping the future of fisheries management. Forestry Management: Director of Forestry Policy John Colclasure dives into the Fix Our Forest Act, wildfire management strategies, and the Cottonwood fix. Hear how new leadership and cross-sector collaboration are driving forestry conservation efforts.   Key Takeaways: Legislative Wins: Bipartisan collaboration remains a cornerstone of successful conservation policy. Action Needed: Supporting initiatives like the Wildlife Movement Through Partnerships Act can have lasting impacts on wildlife corridors. Fisheries Management: Innovative policies and funding mechanisms are crucial for sustainable fisheries. Forest Health: Active management and legislative support are vital for wildfire prevention and forest restoration.   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode of the Bendy Bodies Podcast, Dr. Linda Bluestein welcomes Dr. Petra Klinge, a renowned neurosurgeon specializing in tethered cord syndrome (TCS), Chiari malformation, and cerebrospinal fluid (CSF) disorders. They dive deep into occult tethered cord syndrome, a condition where MRI scans appear normal, yet patients still experience neurological symptoms, chronic pain, and bladder/bowel dysfunction. Dr. Klinge explains how tethered cord affects EDS patients, the role of connective tissue disorders, and what makes someone a good candidate for surgery. Whether you've been struggling with undiagnosed spinal issues or are considering tethered cord release surgery, this episode is packed with valuable insights and cutting-edge research. Takeaways: Tethered Cord Can Be “Occult” (Hidden on MRI) – Many patients with classic tethered cord symptoms are dismissed because their MRI appears “normal.” A clinical diagnosis is key. EDS Patients Are at Higher Risk – Changes in collagen and the extracellular matrix make individuals with Ehlers-Danlos Syndrome more prone to tethered cord syndrome, which can be congenital or acquired. Tethered Cord Syndrome Affects the Entire Spine – While traditionally thought to impact only the lower body, new research suggests TCS can cause upper body pain, weakness, and neurological dysfunction. Surgery Isn't Always the First Step – Physical therapy, craniosacral therapy, and manual techniques may help some patients, but progressive neurological decline may require surgical release. Retethering is Possible After Surgery – Around 7% of patients may need a second surgery due to scar tissue reattaching the spinal cord, but new surgical techniques are improving long-term outcomes. Articles referenced in the episode: https://pubmed.ncbi.nlm.nih.gov/38489815/ https://pubmed.ncbi.nlm.nih.gov/38202013/ https://pubmed.ncbi.nlm.nih.gov/35307588/ Connect with YOUR Hypermobility Specialist, Dr. Linda Bluestein, MD at https://www.hypermobilitymd.com/. Thank YOU so much for tuning in. We hope you found this episode informative, inspiring, useful, validating, and enjoyable. Join us on the next episode for YOUR time to level up your knowledge about hypermobility disorders and the people who have them. Join YOUR Bendy Bodies community at https://www.bendybodiespodcast.com/. Learn more about Human Content at http://www.human-content.com Podcast Advertising/Business Inquiries: sales@human-content.com YOUR bendy body is our highest priority! Learn about Dr. Petra Klinge Website: https://www.brownhealth.org/providers/petra-m-klinge-md-phd Keep up to date with the HypermobilityMD: YouTube: youtube.com/@bendybodiespodcast Twitter: twitter.com/BluesteinLinda LinkedIn: linkedin.com/in/hypermobilitymd Facebook: facebook.com/BendyBodiesPodcast Blog: hypermobilitymd.com/blog Part of the Human Content Podcast Network Learn more about your ad choices. Visit megaphone.fm/adchoices

In this week's episode of The Sportsmen's Voice Roundup, Fred explores the ongoing push in Maine to amend the state constitution to safeguard the right to hunt and fish, diving into the importance of community involvement, the challenges posed by declining hunter participation, and the significance of a unified sporting voice. Fred also covers Arkansas' recent conservation initiatives aimed at supporting outdoor recreation and engaging new hunters. From forest conservation programs to modernizing muzzleloader regulations, we break down the latest legislative updates and how they affect sportsmen.   Takeaways A Right To Hunt And Fish In Maine: Constitutional protections for hunting and fishing are vital for wildlife management and grassroots involvement is essential to secure legislative victories. Forest Conservation Is Top Of Mind: Forest conservation easement programs play a key role in habitat preservation. Gun Bills Set to Wreak Havoc in the West: Colorado, New Mexico and Oregon are all dealing with bills that would negatively impact access and conservation funding. Louisiana: Seeks to modernize language for modern muzzleloading. Priority Legislation in Arkansas: NASC Executive Council president and AR Legislative Sportsmen's Caucus Co-Chair, introduces 3 pro sportsmen's bills in the AR House.   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

▶️ Join a free leadership masterclass: https://www.firsthuman.com/masterclass/ ▶️ Connect with Richard on LinkedIn: https://www.linkedin.com/in/richardatherton-firsthuman/   My guest this week is Dr. Mauro Zapaterra,  a Harvard-trained MD and PhD, directing Multidisciplinary Catatonic Research at the Innovation Medical Group. An expert in cerebrospinal fluid, his work explores its role in the human system, combining insights from both science and spirituality. Dr. Zapaterra's research highlights the dynamic nature of cerebrospinal fluid (CSF), its importance during brain development, and its complex composition. We discuss: The 'aha' moment when Mauro first discovered CSF Virtuous brainwashing DMT, the pineal gland and cerebrospinal fluid Why you should drink more Why heart rate variability is a good thing Links: Dr. Zapaterra's Website

Discussing a question I received asking where the blood brain barrier is located. In addition, we go over information about the blood csf barrier. This is strictly for educational purposes. The information in this video is not meant as a substitute for professional medical advice.Here's a link to the previous video on the blood brain barrier.https://spotifycreators-web.app.link/e/BQceRCwlKRbPlease like, comment and share if you find value in this video. Also, please ask any questions you have about supplements. I'll do a video reply as soon as possible.Resources:https://www.sciencedirect.com/topics/neuroscience/area-postrema#:~:text=The%20area%20postrema%20refers%20to,actions%20that%20lead%20to%20illness.https://qbi.uq.edu.au/brain/brain-anatomy/what-blood-brain-barrier#:~:text=The%20brain%20is%20precious%2C%20and,of%20the%20blood%E2%80%93brain%20barrier.https://www.cancer.gov/publications/dictionaries/cancer-terms/def/choroid-plexushttps://journals.lww.com/glaucomajournal/fulltext/2013/06001/production_and_circulation_of_cerebrospinal_fluid.5.aspxhttps://fluidsbarrierscns.biomedcentral.com/articles/10.1186/s12987-020-00230-3https://my.clevelandclinic.org/health/articles/22266-meningeshttps://pmc.ncbi.nlm.nih.gov/articles/PMC2821375/https://www.frontiersin.org/journals/neuroanatomy/articles/10.3389/fnana.2021.665803/full#F1https://pmc.ncbi.nlm.nih.gov/articles/PMC1871727/https://pmc.ncbi.nlm.nih.gov/articles/PMC7768803/https://pmc.ncbi.nlm.nih.gov/articles/PMC4120694/Image resources:https://www.cancer.gov/publications/dictionaries/cancer-terms/def/choroid-plexushttps://med.libretexts.org/Bookshelves/Anatomy_and_Physiology/Anatomy_and_Physiology_%28Boundless%29/11%3A_Central_Nervous_System/11.3%3A_Protection_of_the_Brain/11.3C%3A_Ventricleshttps://www.hydroassoc.org/understanding-the-choroid-plexus-function-location-and-its-role-in-hydrocephalus/https://www.researchgate.net/figure/blood-cerebrospinal-fluid-CSF-barrier-The-choroid-plexus-has-fenestrated-capillaries_fig1_325373010https://neuroscientificallychallenged.com/glossary/fourth-ventriclehttps://www.researchgate.net/figure/Area-Postrema-is-Anatomical-Marker-for-the-Subregion-of-NTS-of-Primary-Hypothetical_fig1_259320952https://www.rit.edu/spotlights/blood-brain-barrierhttps://www.cell.com/heliyon/fulltext/S2405-8440%2824%2911593-9https://www.aginganddisease.org/EN/10.14336/AD.2022.0130-1http://epilepsygenetics.net/the-epilepsiome/slc2a1-this-is-what-you-need-to-know/https://www.mdpi.com/2072-6643/16/14/2363https://www.mdpi.com/2072-6643/11/11/2636https://www.frontiersin.org/journals/cellular-neuroscience/articles/10.3389/fncel.2019.00282/fullhttps://teachmephysiology.com/immune-system/innate-immune-system/phagocytosis/https://oehha.ca.gov/chemicals/methylmercury-and-methylmercury-compoundshttps://www.mdpi.com/2073-4409/11/18/2823https://www.simplypsychology.org/brain-ventricles.htmlhttps://www.frontiersin.org/files/Articles/123479/fnins-09-00032-HTML/image_m/fnins-09-00032-g001.jpghttps://www.researchgate.net/figure/Cerebrospinal-fluid-flow-Cerebrospinal-fluid-is-mainly-produced-in-the-lateral_fig2_370857837https://www.physio-pedia.com/CSF_Cerebrospinal_Fluid

During this week's edition of the Sportsmen's Voice Roundup, Fred is joined by guest Christian Ragosta, CSF Assistant Manager, Northeast States, to discuss the New York Big Five Trophy Ban. They explore how this legislation could negatively impact African conservation efforts, local economies, and wildlife management. The team highlights the importance of hunting in funding anti-poaching initiatives and supporting local communities. Fred then covers all the rest of the top news affecting sportsmen and women across the nation, including the appointment of Tom Schultz as Chief of the U.S. Forest Service, updates on Iowa legislation affecting sportsmen, red snapper management, the establishment of the Collegiate Sportsmen and Women's Coalition at Penn State, the introduction of hunter education in Georgia schools, and the promotion of trapping education in Idaho.    Takeaways New York's Big Five Trophy Ban is BAD For Conservation: The New York Big Five Trophy Band targets key African species, and is a bad policy that may harm African nations reliant on hunting tourism. US Forest Service's New Chief: Tom Schultz's leadership is crucial for sustainable forest management. As an experienced leader in forestry and public lands management, Tom Schultz will guide a multiple use mission agency that has significantly reduced its timber harvesting levels over the last few decades. Red Snapper Season Update: CSF has testified on the South Atlantic Red Snapper Update at a final public hearing to rectify a one day season in 20204 despite a high abundance of fish.   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

Fred Bird sits down with some of the leaders of the Congressional Sportsmen's Caucus (CSC) in this special ‘Changing of the Guard' episode which focuses on sportsmen's issues and caucus legislative priorities ranging from the farm bill to access bills to wildfire prevention and forestry and beyond. Hear from CSC Co-Chairs Senator John Boozman of Arkansas and Chairman of the House Natural Resources Committee Representative Bruce Westerman, also of Arkansas, as well as CSC Vice-Chairs Representative Troy Carter of Louisiana and Representative August Pfluger of Texas as they speak to some of the priorities that are important for sportsmen and women and how CSC members put aside their differences, working across the aisle, in promoting bipartisan efforts for wildlife management and conservation. Get a glimpse into learning more about their personal outdoor sporting interests, from fishing to spring gobbler chasing, and what their home states have to offer. Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

In the podcast, Swine Extension Educator Sarah Schieck Boelke speaks with Rachel Schambow who is a researcher with the UMN Center for Animal Health and Food Safety at the College of Veterinary Medicine. Rachel speaks about the analysis her and her colleagues did of USDA's Sick Pig Surveillance component at Iowa State University and the University of Minnesota Veterinary Diagnostic Laboratories. She also talks about USDA's Sick Pig Surveillance program in general and how producers and veterinarians can support surveillance for African Swine Fever and Classical Swine Fever. University of Minnesota College of Veterinary Medicine Center for Animal Health and Food Safety have created informational sheets about the sick pig Veterinary Diagnostic Lab's (VDL) surveillance program to help producers and veterinarians understand what it is and how they can participate. There are two versions of the informational sheets - one is aimed towards the intensive commercial swine industry, while the other is aimed more at non-swine veterinarians and general audiences.

During this week's edition of the Sportsmen's Voice Roundup, Fred is joined by Bob Matthews to discuss critical issues surrounding the Knowles-Nelson Stewardship Fund in Wisconsin. Bob Matthews discusses the need for reauthorization of the fund, the implications of a Supreme Court ruling, and the efforts of various coalitions to ensure continued support for hunting and fishing access. Fred then covers the rest of the headlines affecting sportsmen and women across the country, including the advancement of House Bill 3872 in South Carolina, the implications of Colorado's SB3 on gun rights and hunting participation, the reintroduction of the Voluntary Public Access Improvement Act, and the importance of sustainable forestry practices in South Carolina.    Takeaways South Carolina House Bill 3872: House Bill 3872 aims to limit the loss of hunting land in South Carolina. It was reported favorably by the Ag and Natural Resources Committee and was quickly followed by unanimous 110-0 House vote and is now headed to the Senate. Colorado Senate Bill 3: Colorado's SB3 semi-automatic firearms ban is moving in Colorado. The bill has now been amended to allow continued ownership of some semi-automatic firearms popular with hunting and shooting with new requirements - but still threatens to severely limit hunting rights and Pittman-Robertson funding. The Knowles-Nelson Stewardship Fund: 90% of Wisconsin residents support the stewardship fund, which is vital for conservation in Wisconsin. Recent Supreme Court decisions have impacted legislative oversight of the fund, while coalitions are working to ensure the fund's reauthorization.   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

Takeaways Protecting Conservation Funding Is Paramount: Foreign manufacturers often evade taxes that support conservation efforts, while the proliferation of online marketplaces has created loopholes in conservation funding. The GAO now recommends that Congress to addresses the tax collection issue. Washington Trappers And Fly Fishers!: House Bill 1775 in Washington could impact trapping and fly fishing. Discount Licenses For Seniors: Minnesota's House File 276 aims to provide discounted fishing licenses for seniors without harming DNR funding.   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

If you've ever considered an EV conversion but weren't sure where to start, Ryan from ‪@rywire‬ takes us through the technical details of his incredible Honda Civic EK EV swap, showcasing the integration of Tesla drive units, AEM Electronics VCU, and CSF Radiators for cutting-edge performance and thermal management.Use ‘PODCAST75' for $75 off your first HPA course here: https://hpcdmy.co/hpa-tuned-inThis lightweight (EV comparative) build features a $1,000 Tesla front drive unit and a $2,200 rear drive unit, delivering 300hp (each!) with infinite tunability thanks to a Cascadia Motion logic board. Ryan explains why switching from Tesla's OEM controls to standalone AEM strategies unlocks full control over torque split, regen tuning, and thermal strategies—key elements in achieving high performance and reliability.Thermal management is a standout feature, utilizing CSF radiators, Freon-based heat exchangers, and a multi-directional cooling system to optimize temperatures for the motor, charger, and 400V battery pack. With insights from OEM designs, Ryan has implemented a system that ensures the batteries stay in their optimal temperature range, boosting efficiency and performance.Whether you're interested in OEM vs. aftermarket motors, Bosch brake boosters, or regen tuning with paddle shifters, this build is a masterclass in EV conversions. With a range of up to 400 miles and a weight of approximately 3,400 lbs, this Civic is a lightweight powerhouse that sets a new benchmark for EV swaps.By the end of this interview you should understand that EV tuning is as risky as tuning your ICE powered projects, and without a high level of care for any project you undertake, you can potentially damage expensive components.

In this very special sit-down interview, Fred Bird is joined by renowned conservationist and outdoorsman, Will Primos, for a wide-ranging discussion on the importance of conservation, Will's legacy, and the impact hunting and conservation have had on Will's life and our nation. Will shares his personal journey, the evolution of his company, and just how important it is to continue educating future generations about conservation efforts. Fred and Will both then discuss the deep emotional connections sportsmen often have to their firearms and their role in conservation efforts. And finally, Mr. Primos shares his journey of donating a unique collection of guns to benefit five of the nation's greatest conservation organizations, emphasizing the importance of community involvement and the ripple effect such actions have on the greater good.    Key Takeaways: Understanding Will Primos' Legacy: Whether talking official Primos Hunting gear and calls or beyond, dive deep into Will Primos' hunting career and the legacy he hopes to leave behind for sportsmen and sportswomen. Protecting What We Love: Conservation is about protecting what we love and educating others, therefore it becomes necessary to cast a wide net and foster collaboration between various organizations for the benefit of wild places and wild things. Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

During this week's edition of the Sportsmen's Voice Roundup, Fred discusses the latest news in conservation, leading off with conservation legend Will Primos' collaboration with leading organizations to promote, The Truth About Conservation through a HISTORIC firearm auction. Fred then gives several updates on legislative initiatives including RTHF in Iowa, new Hunter Ed programs in Georgia, Massachussetts bear population increase leading to management plan changes, and so much more!   Takeaways Will Primos: Will Primos is leading a campaign to promote conservation awareness by partnering with CSF and other conservation nonprofits to auction off his collection of Purdey side-by-side shotguns - you heard it here first! Tune into the Truth About Conservation Campaign here: Know The Truth | THE TRUTH RTHF In Iowa?: Legislation is being introduced to protect the Right to Hunt and Fish in Iowa, which has seen success in several other states including, recently, in Florida. Great Lakes Restoration Initiative: The Great Lakes Restoration Initiative is vital for maintaining fisheries and access to native fish in the Great Lakes region.   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

During this week's edition of the Sportsmen's Voice Roundup, Fred is joined by CSF's Bob Matthews to discuss the bipartisan support for legislative efforts to introduce hunter education in schools in Michigan and Illinois and the potential impact these bills have on youth engagement in hunting and outdoor activities. Bob highlights the collaboration between the Department of Natural Resources and the Department of Education in Michigan, as well as the challenges and prospects for similar legislation in Illinois. Then, Fred covers all the other news fit to print on conservation and hunting legislation around the country, including the appointment of Governor Gianforte as Chair of the Governors Sportsmen's Caucus, Maryland's misguided proposed lead ammunition phase-out, updates the Georgia Legislative Sportsmen's Caucus, the reintroduction of the Disaster Reforestation Act, and initiatives from the Hawaii Legislative Outdoor Heritage Caucus.    Takeaways Hunter Education In Schools: Hunter education in schools can expand the base of hunters, by providing an elective experience targeted towards teens who have not come from a hunting household that can get them outdoors. Even when ultimately unsuccessful, this kind of legislation introduced now can gain momentum for future sessions. Get To Know The New Chair For The GSC: Governor Gianforte has a strong track record in conservation even before his term as Governor, when he served as a member of the Congressional Sportsmen's Caucus,  Misguided Lead Bans Stand To Hurt Hunting: Incentive-based programs for non-lead ammunition should be encouraged in Maryland, rather than an outright ban. The financial impact of hunting and fishing on conservation funding is significant.   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

As more preventative approaches to health are set to take center stage, some diseases can't be prevented but can be managed more proactively. Blood-based biomarkers, such as p-tau217, hold great promise for earlier, more proactive detection and monitoring of diseases such as Alzheimer's, and it's here that Quanterix plays a critical role.Their Simoa digital health platform serves as the backbone for the majority of p-tau217 tests on the market today, reducing reliance on costly PET and CSF testing and streamlining the diagnostic journey for Alzheimer's disease.Mark has been a leader in the biotech space for over 2 decades, with a string of leadership roles before he joined Quanterix in 2014 and became their CSO in 2022.Mark joined Meg on From Lab To Launch to discuss the exciting predictive power of biomarker technology, and what the future holds for spotting and treating diseases early. Qualio website:https://www.qualio.com/ Previous episodes:https://www.qualio.com/from-lab-to-launch-podcast Apply to be on the show:https://forms.gle/uUH2YtCFxJHrVGeL8 Music by keldez

Fred and the Congressional Sportsmen's Foundation have a big show today - with not one, but TWO, members of the Governors Sportsmen's Caucus joining the program. Kicking things off is CSF's Vice President of Policy Brent Miller who speaks to the history of the Governors Sportsmen's Caucus, then hear from the new Chair of the Governors Sportsmen's Caucus, Montana Governor Greg Gianforte and member of the Governors Sportsmen's Caucus Wyoming Governor Mark Gordon who talk about some of the sporting issues that matter to their states, what they're working on in the year to come, and so much more! Meanwhile, in the second half of the show Fred was able to catch up with Angi Bruce of Wyoming Game And Fish as well as CSF Board Members Joe Bartozzi of NSSF and Brandon Maddox of Silencer Central at CSF's SHOT Show reception!   Key Takeaways: Montana Governor Greg Gianforte: Governor Gianforte, the new Chair of thew Governors Sportsmen's Caucus, joins the program from the floor of SHOT show in Nevada to discuss our hunting and fishing heritage, the sporting issues states are fighting for, an outlook on the new federal administration, and (of course!) a shameless plug for the Sportsmen's paradise of Montana! Wyoming Governor Mark Gordon: Governor Gordon discusses troubling 2A legislation nationwide and the comfort states receive from the support they count on in Congress fighting back against the ‘bad' bills, and more. Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

During this week's edition of the Sportsmen's Voice Roundup, Fred is joined by CSF Senior Manager for the Western and Midwestern States Kent Keene with some exciting news - Governor Mike Kehoe of Missouri is the 23rd active member of the Governors Sportsmen's Caucus! Then, Fred covers other important news to the sporting community including the return of the annual attack on the New Hampshire Fish and Game Commission, Doug Burgum's rise to Secretary of the Interior, Congressional Sportsmen's Caucus leadership for the 119th Congress, Arkansas Forestry Day at the state capitol, priority access legislation in South Carolina, and more!   Takeaways A New Secretary Of Interior: Doug Burgum's confirmation as Secretary of the Interior is crucial for conservation efforts, and was strongly supported by CSF, as it heralds a new direction for an agency with immense regulatory control of sporting enthusiasts. Access And Activism: Arkansas spent some time celebrating the importance of forestry management for wildlife and economy, meanwhile South Carolina introduced legislation to protect hunting access amid population growth. Big WINS For CSF: Thanks to the support of listeners like YOU, we are in the Top 5 of the Apple charts for outdoor podcasts!   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter Sign up for FREE legislative tracking through CSF's Tracking the Capitols tool: www.congressionalsportsmen.org/tracking-the-capitols/ Learn more about your ad choices. Visit megaphone.fm/adchoices

The spread of high-risk human and animal diseases across borders in the last five years has clearly demonstrated that the best-laid plans can go wrong when it comes to infectious disease control and prevention. In fact, North American and European countries proved decades ago that swine diseases like ASF and classical swine fever can be eradicated through effective government policies, even without ideal vaccines. However, the world has since changed.Joining our Ann Hess to discuss this topic and more from the PRRS Symposium in Chicago is Dr. Jishu Shi of Kansas State University. Dr. Jishu Shi's research team develops vaccine adjuvants, novel diagnostic assays and vaccines for swine infectious diseases. Specifically, his team focuses research on African swine fever (ASF), Streptococcus suis, swine influenza virus (SIV), classical swine fever (CSF), porcine reproductive and respiratory syndrome (PRRS), and other emerging infectious diseases of swine.This episode of Feedstuffs in Focus is sponsored by United Animal Health, a leader in animal health and nutrition. You can learn more about United Animal Health and how they are working to advance animal science worldwide by visiting the website at UnitedANH.com

Fred is working the floor at SHOT Show and sits down with CSF partners at Traditions. Tom and Allison Hall, talk about all things muzzleloading, the new firestick technology, and new products like Traditions' own NitroBolt – the first Firestick-capable bolt action muzzleloader which was test fired at Industry Day at the Show. Key Takeaways: Check Out Traditions' NitroFire: This award winning firearm teamed up with Hodgdon Powder and Federal's new Firestick technology to increase muzzleloader reliability, safety and accuracy New Technology Makes Muzzleloading Accessible: This revolutionary new technology stands to welcome back hunters (and their hunter dollars spent on more gear, additional tags, and more days afield) to muzzleloading by providing a reliable, safe and accurate platform. Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter   Episode: https://www.dropbox.com/scl/fi/cnu8coavovnbqlerwr30t/38_Traditions-01-23-25.mp3?rlkey=ujk6qf9jql9dh7khiz0zk9mqg&st=6yi5xtij&dl=0 

Fred is joined LIVE from SHOT Show 2025 by Taylor Schmitz, Director, Federal Relations. They discuss Congressional Sportsmen's Caucus members getting to work on new legislation in 2025, CSF's new year end report (available now), 3 CSF priorities set to receive vote on the House floor, efforts to maintain recreational shooting on 1.3 million acres of public land, and so much more!   Takeaways Caucus Members Getting To Work: A tremendous week for sportsmen in DC saw the introduction of the Hearing Protection Act, the Sporting Firearms Access Act, maintaining recreational shooting access at Bear's Ears Monument, and more! The Fix Our Forests Act And Fire Management: The Fix Our Forest Act aims to improve forest health by putting tools in the hands of land managers to maintain great habitat free of destructive wildfires. CSF's Year End Report is now available here for your review: https://online.fliphtml5.com/ainum/hchh/#p=1 Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter

Running a 725hp Texas Speed LS-based build and TREMEC Magnum transmission, Cam Cocalis has followed on from his LS3 V8 Toyota 86 build with a full chromoly tube frame BMW E30 Vert project and pushed himself to dive into some new build aspects, a C6 Corvette suspension swap in particular, as he continues to learn the ins and outs of fabrication and custom car building.Use ‘PODCAST75' for $75 off your first HPA course here: https://hpcdmy.co/hpa-tuned-inAt the ‪@toyotires‬ booth during ‪@semashow‬ Cam gives us some insight into his welding progression and working process without the use of CAD, with that being a skill he wishes to learn during future projects. The CSF triple pass radiator is rear mounted to aid with weight distribution, and interestingly, this model of E30 came with rear ballast from the BMW factory. The Radium Engineering fuel system behind the Ford 8.8 rear diff also helps to get weight over the rear and a 48/52 split.The Redux Racing ITB-equipped 7L LS-based engine is controlled by a suite of Haltech electronics, and a Live To Offend kit is fitted to the E30 care of SOS Customs handiwork. We didn't get a rundown on the full brake package, but a Wilwood pedal box is equipped which will serve Cam well if he decides to hit the track for some time attack racing in the future.

The Textile Innovation Podcast speaks to Monica Buchan-NG, head of knowledge exchange (sustainability) at Centre for Sustainable Fashion. Centre for Sustainable Fashion (CSF) is a research, education and knowledge exchange centre of the University of the Arts London (UAL) based at London College of Fashion (LCF). Recently it was announced Kering has teamed up with CSF for a new three-year programme called Governance for Tomorrow. Marking the 10th anniversary between the Gucci owner and LCF, the new programme is aimed at addressing governance in the luxury fashion sector, an industry that lacks examined means for leading sustainable transformation, according to CSF. During the three years, the programme will aspire to use creativity as a tool to dissolve barriers and convene experts from across academia, luxury fashion and non-governmental organisations (NGOs) to foster new alternative governance models. In episode 107 of WTiN's Textile Innovation Podcast, we speak to Monica Buchan-NG, head of knowledge exchange (sustainability) at Centre for Sustainable Fashion about the partnership and the need for more action at senior management level to action environmental and social change. We explore how the relationship between industry and academia has developed. Buchan-NG also emphasises why change needs to be imminent as fashion lags behind other industries on key sustainability concerns such as responsible production and consumption, decarbonising supply chains and ensuring living wages for garment workers. If you would like to learn more, please visit sustainable-fashion.com. You can listen to the episode above, or via Spotify and Apple Podcasts. To discuss any of our topics, get in touch by following @wtincomment and @abi_wtin on X, formerly Twitter, or email aturner@wtin.com directly. To explore sponsorship opportunities, please email sales@wtin.com.

Dr. Alex Menze and Dr. Adrian Budhram discuss the clinical utility of cerebrospinal fluid correction factors for traumatic lumbar punctures. Show reference: https://www.neurology.org/doi/10.1212/CPJ.0000000000200350  

Dr. Alexander Menze talks with Dr. Adrian Budhram about the common challenges faced by neurologists when interpreting cerebrospinal fluid (CSF) results, particularly in cases of traumatic lumbar punctures. Read the related article in Neurology: Clinical Practice. Disclosures can be found at Neurology.org.  

Anti-amyloid therapies provide the first FDA-approved option to alter AD pathology, but an understanding of overall utility and value to patients remains in its infancy. In this episode, Teshamae Monteith, MD, FAAN, speaks with David S. Geldmacher, MD, FACP, FANA, author of the article “Treatment of Alzheimer Disease” in the Continuum® December 2024 Dementia issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Geldmacher is a professor and Warren Family Endowed Chair in Neurology and the director of the Division of Cognitive and Behavioral Neurology, Department of Neurology, Marnix E. Heersink School of Medicine at the University of Alabama at Birmingham in Birmingham, Alabama. Additional Resources Read the article: Treatment of Alzheimer Disease Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Transcript Full interview transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME. Dr Monteith: This is Dr Teshamae Monteith. Today, I'm interviewing Dr David Geldmacher about his article on treatment of Alzheimer's disease, which appears in the December 2024 Continuum issue on dementia. Welcome to our podcast, Dr Geldmacher. How are you?  Dr Geldmacher: I'm very well, thank you. It's a pleasure to be here.  Dr Monteith: Yeah. So, why don't you introduce yourself to our audience? Dr Geldmacher: Sure. I'm David Geldmacher. I'm a professor of neurology at the University of Alabama in Birmingham and I lead the division of Cognitive and Behavioral Neurology.  Dr Monteith: So, I'm really excited about this, to personally learn, and I know that or neurology community is also really excited about this interview. So, why don't we start off with your main objective.  Dr Geldmacher: So, my main goal in the article was to review the FDA-approved pharmacologic treatments for dementia. There's lots of ways of thinking about treatment of dementia; psychosocial, caregiver support, and so forth. But I really wanted to focus on the issues of drug treatment because that's what has been our backbone for a long time and now has recently expanded.  Dr Monteith: Why don't we talk a little bit about, first of all, the boom in the field? What's that been like?  Dr Geldmacher: So, the big change in the field is over the last several years, we've had treatments become available that actually attack the underlying Alzheimer pathology, and that's new and different. For decades, we've been able to treat the symptoms of the disease, but this is the first time we've really been able to get to the root of the pathology and look toward removing amyloid plaques from the brain.  Dr Monteith: Let's step back a little bit and talk about the framework of diagnosis and how that leads into the therapeutic potential. I know you're going to dive into some of the biologics, but we should probably talk about the kind of holistic approach to considering the diagnosis. Dr Geldmacher: Sure. So, you know, when someone comes to the clinic with memory complaints, our question we have to ask is, is this neurologic origin, a structural origin like Alzheimer's disease or vascular dementia? Are there complicating factors, the software issues of mood disorders and sleep disorders and pain that can all magnify those symptoms? The clinical reasoning is a critical part of that, but in Alzheimer's disease, typically the problems revolve around difficulty forming new memories of events and activities, the episodic memory. And then it's often accompanied by changes in word finding and semantic knowledge. And those are the things that we look for in the clinic to really point toward an AD diagnosis. And then we support it with exclusion of other causes through blood work and identification of patterns of brain atrophy on MRI. And then most recently in the last couple of years, we've been able to add to that molecular imaging for amyloid with PET scans as well as, most recently, blood-based biomarkers for Alzheimer's pathology. So, it's really been a revolution in the diagnosis over these last several years.  Dr Monteith: And when approaching patients or populations of individuals, there seems to be a real full spectrum with looking at the societal burden, the biological impact, of course, risk factors of primary prevention, and now this whole area of brain health and secondary prevention. How do you kind of tie all of this together when talking to patients and family members?  Dr Geldmacher: Sure. So, the approaches for brain health apply to everyone. In basically every clinic visited, our brain aging and memory clinic, we reviewed lifestyle approaches to brain health like regular physical exercise, healthy diet, cognitive and social stimulation. And those are fundamental to the approach to everyone, whether they have cognitive impairments that are measurable or not. These are all things that are good for our brain health. And then, you know, focusing on the vascular risk factors in particular and working with the patient and their primary care team to ensure that lipids and blood sugar and blood pressure are all in good healthy ranges and being appropriately treated.  Dr Monteith: You know, there's this kind of whole considerations of clinically meaningful endpoints and clinical trials, and even when we're talking to our patients. What would you say the field has kind of identified has the best endpoints in helping patients? Would you call it impaired daily function? Is that like the best hard endpoint? Obviously, there are other things such as caregiver burden, but you know, how do you approach assessing patients? Dr Geldmacher: Defining the endpoints is very difficult. Typically, if we talk to patients and their families, they would like to have better memory or improve memory. How that applies in everyday life actually is daily function. And so, we focus very much on daily function. And when I talk about our therapies, whether they're symptomatic therapies or the new disease-modifying therapies, I really talk about maintenance of function and delays and decline or slowing of decline, helping to foster the person's independence in the activities that they have and be able to sustain that over the longer term.  Dr Monteith: And when thinking about diagnosis- and we're going to get into treatments, but when thinking about the diagnosis, and of course, it's full-spectrum from mild cognitive impairment to moderate and severe forms of dementia, but who should have CSF testing and PET imaging? Obviously, these are invasive, somewhat invasive and expensive tests. Should all people that walk in the door that have memory complaints? How do you stratify who should have tests? Dr Geldmacher: I think about this in a big funnel, basically, and the starting point of the funnel, of course, is the person with memory complaints. Then there's that neurologic reasoning. Are these memory complaints consistent with what we expect from the anatomy of Alzheimer's disease, with atrophy in in the hippocampus and temporal lobe? Do they have episodic memory loss or not? That first step is really trying to characterize, do the clinical patterns act like those of Alzheimer's disease or not? And then we follow the Academy of Neurology guidelines, looking for reversible sources of cognitive decline, things like B12 deficiency and depression, sleep disorders and the like, and try to exclude those. We start with structural imaging with everyone, and MRI, typically, that will help us understand vascular burden and patterns of atrophy, looking for things like mesial temporal atrophy or precuneus atrophy that are characteristic of Alzheimer's disease. If those things are all pointing in the direction of AD as opposed to something else, then typically before moving on to CSF or PET scan, we will use blood-based biomarkers, which are one of the big changes in the field in the last year or so, and there are now multiple panels of these available. The downside is they are typically not covered by insurance. On the other hand, they can really help us identify who is likely to have a positive PET scan or positive findings on CSF. We start to provide that counseling and information to the patient before they get to those more definitive tests. We can push people in the other direction. We can say, your blood-based biomarkers are negative or do not indicate AD as the most likely source of your condition now, so let's treat other things. Let's see what else we can focus on. The blood-based biomarkers are now, in our clinic at least, the critical choke point between the routine workout that we've always done on everyone and then the more advanced workup of proving amyloid pathology with CSF or a PET scan. Dr Monteith: How sensitive are those blood biomarkers and how early are they positive?  Dr Geldmacher: The sensitivity is generally pretty good, in the ninety plus percent range on average and it depends on which panel. And as you point out, when in the course of symptoms that they're done, we know that they become positive and presymptomatic or asymptomatic people. We're using these kinds of markers to screen people for prevention trials. So, I think when someone is symptomatic, they're a good indicator of the presence or absence of AD pathology. Now that doesn't mean the AD pathology is the sole cause of their symptoms. And so, we still need to think about those other things like sleep and mood and so forth. But they do point us in the in the direction of Alzheimer's change.  Dr Monteith: So why don't we talk about some of the more standard older treatments, and it's also important to leave with kind of some rational approach to when we start and what should we be counseling our patients on. So why don't we start with the older, you know, choline esterase inhibitors and then some of the MDA- I guess there's only one modulator, SEPTA modulator. Dr Geldmacher: So, I've been really fortunate in my career span, the time from the first of those symptomatic agents reaching the market in 1993 to seeing the disease modifying drugs enter the market now. I think most neurologists actually have entered practice after those clinical trials of the colon esterase inhibitors were published. So, one of my goals in this article was to review that primary data and what can we expect from those symptomatic drugs. We know that they are inconsistently effective in mild cognitive impairment, and the Academy of Neurology guidelines says there is not strong evidence to use them in mild cognitive impairment. But in mild AD and beyond, the cholinesterase inhibitors provide meaningful benefits. They delay decline, they can delay nursing home placement. They reduce overall costs of care. So, I think they provide real value. So, in the article I have reviewed what the data looked like on those. My approach is to start with oral Donepezil at five milligrams and increase it to ten in everyone who tolerates the five. If for whatever reason the oral Donepezil is not well tolerated, I'll switch to transdermal rivastigmine to help improve tolerability. There are very few head to head comparisons, but nothing suggests that one of the cholinesterase inhibitors is superior to the other for clinical outcomes, and there's no evidence to support conjoint use of more than one at a time. Should someone be showing decline then on typical cholinesterase inhibitor therapy - and people will, it's often delayed, but the decline will reemerge - then I will add the NMDA receptor, a modulator memantine and titrate that up to full dosing, either 10 mg twice a day for the conventional release or 22 mg extended release. And at that point we're sort of on maximal pharmacologic therapy for Alzheimer's disease. These agents can provide some benefit in other conditions, they're off-label except for Lewy body disease where rivastigmine is labeled. But they can provide benefit across different conditions. And there's some preliminary data, for instance, of acetylcholinesterase inhibitors being helpful in vascular cognitive impairment. So, I will use them, but I expect the greatest response when someone really does follow the patterns of Alzheimer's disease.  Dr Monteith: And you have a great chart, by the way, and nice figures looking at some of the meta-analyses on cognitive outcomes as well as functional outcomes. So, thank you for that.  Dr Geldmacher: In general, all of those tables favor treatment over placebo in the domains of cognition, daily function, neuropsychiatric symptoms. And it's that consistency of result that lets me know that we really are seeing a drug effect, that it's not a class effect with those, that we really are helping our patients. It's not like some studies are positive and some are negative. They are very consistently positive. Small magnitude, but consistently positive.  Dr Monteith: And I know we have a lot of patients coming in where, at least, their caregivers are complaining about agitation, and sleep is also a problem for others. And so how do you help that patient? I know you have a good algorithm that also you included in your article, but why don't you summarize how we should approach these symptoms? Dr Geldmacher: Sure. So, for nonpsychotic agitation, you know, just restlessness, wandering, pacing and so forth, my first choice is an off-label use of citalopram. And there is good clinical trials evidence to support that. if someone has psychotic agitation that is with delusions or hallucinations and so forth, I think we do need to move to the antipsychotic drugs. And the one drug that is now approved for treatment of agitation and Alzheimer's disease does fall into that antipsychotic category, along with its various black box warnings - and that's brexpiprazole. For many of our patients, getting coverage for that agent is difficult. It's not on many formularies. So, it is something I progress toward rather than start with. Similarly, for sleep, there is one approved agent for sleep, that's a dual orexin agonist. And it shows effectiveness, but can have some negative cognitive effects, and so I tend not to start with that either. My first choice when sleep is the primary issue for our patients with dementia is trazodone, and there are some small, limited studies for it's off-label used to enhance sleep. It's safe, inexpensive, often effective, and therefore it's my first choice. Dr Monteith: So, now let's get into the big conversations that everyone is having. Let's talk about the newer disease modifying anti amyloid therapies. Give us a summary dating back 2021 probably, although we can hold the preclinical work, but let's talk about what is available to our patients. Dr Geldmacher: Sure. And the development of anti-amyloid therapies goes all the way back to 1999. So, it's a pretty long course to get us to where we are today.  Dr Monteith: Yeah, that's why we limited that.  Dr Geldmacher: With that first approved agent with aducanumab in 2021, it received a limited or accelerated approval in FDA parlance. These agents, the aducanumab, lecanemab and donanemab, all approved, are known to remove amyloid pathology from the brain as measured by CSF and/or BIPET. They are amyloid lowering therapies, often called disease-modifying therapies. And across the agents there's some variable results. But if we look at the two with full approval, lecanemab and donanemab, they slow clinical progression by 25% to 35% on average. And that's measured by either cognitive measures or global measures or composite measures, but it's pretty consistent in that range of about one-third slowing. That makes it really difficult to discern in an individual patient, though, because there's so much variability in the progression of the disease already that it can be difficult to tell in one person that these drugs are working. They're also complex to use, so there's a qualification process that involves MRI to exclude things like a high tendency toward hemorrhage. It includes genetic testing for papal E4 status to help us understand the risk for complication, and then once-monthly or twice-monthly infusions with standardized schedule for MRI scanning. So, there's a lot that goes into managing these agents. And they are expensive, and we don't yet know their cost effectiveness. The cost effectiveness of the cholinesterase inhibitors was questioned when they first came out back in the 1990s, and it took five or ten years to really understand that they provided benefit to society and to individuals in those domains of quality of life and return on investment. And we're still learning about that with the disease modifying therapies.  Dr Monteith: So, two questions. One, the case that you presented was an individual having symptoms and kind of voiced their desire to be on these therapies. So, people are going to be asking, coming to clinic asking and then of course, they're going to be people that you select out. So, how do you make that decision to recommend this treatment for patients given the potential risk? Dr Geldmacher: We've got some really good guidance from appropriate use recommendation papers for aducanumab and lecanemab, and I'm expecting one from donanemab fairly soon. But the key is to identify individualized risks, and that involves knowing their APOE4 status, knowing their- whether they've had microhemorrhages in the brain previously, and then documenting that they really do have amyloid pathology with something like PET scan to establish those baselines. I talk to people about the burden of twice-monthly infusions or, now with donanemab, once-monthly infusions. And for instance, for someone who's got a working caregiver, getting to an infusion center twice a month can be a significant burden. And then if there are complications, frequent MRI scans and so forth. So, we talk about the burden of entering into this therapeutic pathway. The reality is that people who are qualified generally want it. I have relatively few folks who have said, no, these risks are more than I'm willing to accept. For decades my patients have said, anything you can do to slow this down, I'm willing to try. And now we're seeing that translated to reality with people willing to accept high-risk, high-cost treatments with the chance of slowing their individual progression.  Dr Monteith: And how do you select between the two treatments? Dr Geldmacher: So far that's been easy because donanemab's not readily available.  Dr Monteith: Outside of clinical trials, right?  Dr Geldmacher: Exactly. For prescription use, it's coming in - the first cases have now been infused - but it's not generally available. Nonetheless, what I will do for patients in this is look at the risk tables. So donanemab appears to have in general some higher rates of the Aria complications, amyloid-related imaging anomalies, and some people are going to be more risk tolerant of that for the payoff of potentially faster response. The donanemab trials restructured that. They did their first assessment of effectiveness. I had amyloid removal at six months and a significant proportion of people were eligible to discontinue treatment at six months because their amyloid was below treatable thresholds. So higher risk, perhaps faster action and fewer infusions for donanemab. Lecanemab we have more direct experience with, and between the two of them, the eighteen month outcomes are pretty much the same and indistinguishable. So are we in it for a quick hit, or are we in it for the long race? And different patients and different families will have differing opinions on where they want to accept that risk and burden and so forth. But so far, the data don't indicate a lot of difference in their longer-term outcomes. We still have plenty to learn.  Dr Monteith: And so, it sounds like, as you mentioned, we're looking at eighteen months out for kind of a hard outcome, and that there is a lot of variability in response rate. How are you tracking patients- you know about the imaging, so just in terms of clinical outcomes and efficacy?  Dr Geldmacher: Sure. So, for Medicare to reimburse on these treatments, people need to be enrolled in a registry program - and there are several of these, CMS runs one of their own. But the requirement for that is, every six months, to do cognitive and functional outcomes through the first two years. Cognitive outcomes are up to the clinician, but things like the mini mental state exam, the MoCA, are appropriate. In our own program, we use something we developed locally called the Alabama Brief Cognitive Screener. As for the cognitive outcomes and then for functional, we use an instrument called the General Activities of Daily Living Scale, but there are many other ADL scales that could be used as well. CMS does not mandate specific tests. Since the progression of the disease is variable to begin with, we don't really know how to interpret these results in reference to whether the drug is working, but I can tell a patient or a family member, your scores are stable, or, you have a decline of three points in this test. That's typical for this duration of illness. But there isn't a good way to know whether the drug is working in this person at this time, at least with our current levels of data.  Dr Monteith: So, I think we have to talk about health equity, and it sounds like Medicare is reimbursing for some of us. We look at different socioeconomic backgrounds, educational backgrounds, race, ethnicity. Not everyone is aware of these treatments. So, how do we get more patients to become aware of these treatments? And how do we get them to more people to help people? Dr Geldmacher: Yeah, I mean, that's- it's a major, major issue of inequity in our population. We've done some work at UAB looking at the flow of members of minority communities into memory clinics. So, we know that the overall population of, and I'll choose, for an example, blacks and African Americans, that they are represented a much higher rate in our overall UAB treatment population than they are in our memory clinic population. So, they're not even getting to us in the specialty clinic at the same rates as other segments of our population. We also know that blacks and African Americans in our population are not receiving PET scans as often as the overall treatment population. So yes, there are real, real problems with access. There are cultural issues behind this as well. And in many communities, a change in cognition, a loss of memory is an expected part of the aging process rather than recognized as a disease. So, people who come to us from minority communities are often further along in the course of cognitive and functional decline and beyond the point where they might qualify for the disease-modifying therapies, where early AD is the sort of defining boundary. So, I think more awareness and more screening in primary care settings, perhaps more community outreach to let people know that changes in memory that affect daily function are not normal as part of the aging process and should be evaluated for intervention. So, there's lots of places in our healthcare community where we could foster better outreach, better knowledge to get more folks access to the medicines. And this is before we even get to cost. Dr Monteith: Yeah, yeah. And obviously, there's some stigma as well.  Dr Geldmacher: That's right.  Dr Monteith: Really recognizing what the issues are and diving and asking those questions and funding research that asks those questions, as you mentioned, is really important. And then you have also a nice area where, you know, looking on the impact of treatments on caregiver-related outcomes, and of course ultimately want to keep patients out of nursing homes and prevent death. And so, can you talk a little bit about that? And, you know, mainly the caregiver burden.  Dr Geldmacher: So, my research in that area goes back a long way now. But I learned early in the course of therapy that many times the outcome that the family is noticing for symptomatic therapies is not a change in the patient's memory per se, but that there is less work involved in the caregiving. Less time is spent in direct caregiving roles. The patient may shadow less and because they have better independent cognition. I remember one family member once told me, the medicine you started is a godsend because now I can go to the bathroom by myself and he's not pounding on the door saying where are you, where are you. He's able to recall long enough that I'm in the bathroom that I have that moment of privacy. That was very meaningful to me to hear that. So. Dr Monteith: Cool. So why don't you just help us wrap this up and just give us, like, three main takeaway points that we should be getting out of your article? Dr Geldmacher: The three points that I would emphasize from my article is that the symptomatic therapies provide meaningful benefits and measurable, consistent, meaningful benefits. The second is that those benefits extend beyond things like cognitive test scores and into things like caregiver well-being and maintenance of independence in the home environment. And the third is that the disease-modifying therapies are an exciting opportunity to modify the pathology, but we still are learning about their cost effectiveness and their long-term benefit both to individuals and to society. But the only way we're going to learn that is by using them. And that was the experience that we gained from the symptomatic therapies that took use in the community for years before we really began to understand their true value. Dr Monteith: Thank you. That was excellent. And I put you on the spot, too.  Dr Geldmacher: No problem.  Dr Monteith: Again, today I've been interviewing Dr David Geldmacher, whose article on treatment of Alzheimer's disease appears in the most recent issue of Continuum on Dementia. Be sure to check out Continuum audio episodes from this and other issues. And thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, associate editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at contentpub.com/AudioCME. Thank you for listening to Continuum Audio.

New year, new problems? Or new opportunities to win for conservation? In this episode, Fred Bird and Brent Miller discuss CSF's exclusive forecast for what to expect for sporting legislation in 2025 - including new legislative challenges and opportunities for the sportsmen's community, the importance of state-level wildlife management, and the impact of new leadership within CSF's own board. Brent emphasizes the need for proactive strategies to advance pro-hunting and fishing policies, including the establishment of Wildlife Councils for Public Education and the integration of hunter education into schools. They also address the importance of retaining young hunters through College Student Licenses, and much more! Key Takeaways: New Year, New Challenge: The new year brings new legislative challenges and opportunities. New board leadership is energizing the sportsmen's community. CSF's Crushing It: The organization saw a record state legislator membership in 2024 and held a record-setting Annual NASC Sportsman-Legislator Summit. Introduced anti-sportsmen bills are on the rise, but pro-sportsmen bills are still passing in far greater numbers, thanks to CSF's bipartisan, bicameral caucus leadership. Retaining Hunters Is A Strategic Play: Integrating hunter education into schools can foster interest in outdoor activities. Meanwhile, college student licenses can help retain young hunters who have shown an interest in the outdoor sports.   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter

Blood-based biomarkers for dementia diagnosis are emerging and rapidly evolving. These fluid biomarkers should be used when the results will impact management decisions, including patient and family counseling, symptomatic therapies, and disease-modifying therapies. In this episode, Allison Weathers, MD, FAAN, speaks with Joseph F. Quinn, MD, FAAN, an author of the article “Fluid Biomarkers in Dementia Diagnosis,” in the Continuum® December 2024 Dementia issue. Dr. Weathers is a Continuum® Audio interviewer and associate chief medical information officer at the Cleveland Clinic in Cleveland, Ohio. Dr. Quinn is a professor in the Department of Neurology at Oregon Health & Science University in Portland, Oregon. Additional Resources Read the article: Fluid Biomarkers in Dementia Diagnosis Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Transcript Full interview transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME. Dr Weathers: This is Dr Allison Weathers. Today, I'm interviewing Dr Joseph Quinn, author along with Dr Nora Gray, of Fluid Biomarkers in Dementia Diagnosis from the December 2024 Continuum issue on dementia. Welcome to the podcast and please introduce yourself to our audience. Dr Quinn: Sure. I'm Joe Quinn. I'm a neurologist at the medical school in Oregon, Oregon Health Science University, and I work in neurodegenerative disease, Alzheimer's disease, and Parkinson's disease.  Dr Weathers: Certainly some really weighty topics. But again, as I said, today we want to focus on a really fascinating one, the concept of fluid biomarkers in dementia diagnosis. And we'll perhaps get into monitoring of treatment as well. So, this search for reliable biomarkers in the diagnosis of dementia, certainly not a new topic, but you and your co-author Dr Nora Gray did a really fantastic job in the article right from the get-go, laying out the urgency around this now that there are FDA of treatments that depend on pathologic diagnosis. And it feels like they're more and more announced by the day. Even as I was preparing for this interview a few days ago, the FDA approval for donanemab was announced, with the news making every major media outlet. Well, there are several really critical points made by you both in the article. What do you feel is the most important clinical message of your article? What do you want our listeners to walk away with as their one key takeaway?  Dr Quinn: I think we still have the best evidence for CSF biomarkers, cerebrospinal fluid biomarkers, really making a diagnosis with some confidence. PET scans are available for visualizing amyloid and Tau now, but they're so expensive and they're not covered. So, the spinal tap information is what most of us around here really rely on when we want to be sure about what's going on. The blood tests are very promising, very exciting, but as you probably know, there's a lot of different opinions about this out there. Some people are sure that it's a done deal and that we now have a blood test for Alzheimer's disease. After I sent the article off, I opened up my issue of Neurology and there was an editorial saying these blood tests will never work. So, there's different ends of the spectrum on this and we tried to strike a balance with that. So they're very promising. I think before the article is due for revision, things are going to be different. But right now, spinal fluid is probably where we have the most confidence. Dr Weathers: I think that's a really solid takeaway to start our discussion with. And then, I think you both did really strike that very delicate balance in what is right now an area where, as I said, you know, things still are changing by the day. I know for our listeners who do subscribe, and I hope that most of them do, Table 9.1, clinically useful CSF biomarkers for the differential diagnosis of dementia, is one that I personally think I will frequently return to. You and Doctor Gray did just a wonderful job organizing these very complex concepts into an easy read and really powerful tool, especially for use at the bedside. Along the lines of knowing which biomarker to use, how frequently routine care are you ordering these tests on your patients? And do you anticipate this changing the media future? Is this another one of those things that by next week, we'll have a different kind of answer in how we use these tests? Dr Quinn: Yeah, as you said in your preliminary comments, the whole picture has been changed by the approval of these antibody therapies for Alzheimer's disease, lecanumab and just last week, donanemab. Prior to the approval of those two medications, I didn't use spinal fluid tests routinely, but I relied on them when I really needed to make a diagnosis with certainty of something really important hung in the balance. If we were trying to rule out some other treatable, more treatable problem. You know, for example, if it was a question of whether somebody primarily had a psychiatric problem or a neurodegenerative disease, this is something that would really allow me to objectify things. And- but that was a minority of people that I would see for dementia evaluation. You know, now that the two therapies are approved, I'm not actively engaged in administering those therapies very frequently but I can see already that the, the patients that I am discussing this with that spinal fluid is where we're probably going to rely for making a diagnosis of the amyloid burden in the in the living patient until PET scans are approved. If amyloid PET scans are- not approved, but covered by insurance, then those will probably replace the spinal fluid. So those tests in that table, A beta 42, tau, p-tau, one of them that's relatively new is this test for aggregated alpha-synuclein. Those I order with some frequency when I'm in those circumstances.  Dr Weathers: That's really helpful for our listeners to hear from an expert such as yourself and to think about as they encounter similar patients. Whenever discussing complex topics such as this one, I'm always curious about, what is the most common misconception or pitfall regarding the use of biomarkers for the diagnosis of Alzheimer's and other dementia that you encounter?  Dr Quinn: With respect to the blood biomarkers, you know, we were saying a moment ago that there's a lot of evidence available, but the jury is still out to some degree as to how reliable they are. And I think an important message with respect to those blood biomarkers is that they really are confounded by comorbidities. Remember, we're dealing with an elderly population, so comorbidities like hypertension and renal insufficiency and those kinds of things are relatively common and they can really throw off the blood biomarkers in a more dramatic way than cerebrospinal fluid biomarkers. The other fact, and I can't remember how well we cited this in the article, was that the blood biomarkers don't perform as well in underrepresented minorities. And you know, all of us are appropriately paying more attention to that problem in our practice of medicine. And for these blood biomarkers, that's a real issue. And whether the inferior performance in underrepresented groups is due to more comorbidity or just due to genetic differences is unclear at this time. So those are really important cautions. We mentioned the renal insufficiency and, I think, some of the other comorbidities, but it's a reason to really be careful with the blood biomarkers.  Dr Weathers: I think a really important point, especially again, kind of going back to what we were talking about at the beginning of our discussion, there's so much excitement around them. There's so much potential. People think we finally have that kind of silver bullet of diagnosis. So, I think really something to keep in mind.  What about in the use of their- in monitoring the efficacy of treatments?  Dr Quinn: So that's I think a little earlier in its history in terms of what biomarkers would be useful for monitoring. But the donanemab trial really relied on blood biomarkers as outcome measures and really showed some interesting phenomena. One of them was that plasma neurofilament light, which is all the rage now and all over neurology, people are measuring plasma neurofilament light. It's a nonspecific marker of neuronal damage that makes it out into the serum. So, you can measure it in serum and detect CNS damage in the serum. And intuitively, you would think that would be a good measure of efficacy, but in terms of detecting a treatment effect with donanemab, it didn't perform very well. Conversely, GFAP, which is a marker of astrocyte activation, which I would not have predicted was going to be a sensitive marker for treatment efficacy, performed well in at least the donanemab trial. So, I think it's early in the history of using these markers as outcome measures in clinical trials. And I think we're going to continue to learn as each therapy comes along and as these things come to pass.  Dr Weathers: Don't make any assumptions yet? Would that be a good way to sum that up?  Dr Quinn: I think that's, yes. I think that's very fair that that we have to be careful about these things.  Dr Weathers: OK. So, in summary, I think, does it sound like it's fair to say that the pitfall might be to say it's too early to make any assumptions or any conclusions quite yet? Dr Quinn: That's right. And, and I think, you know, we're going to need to monitor these therapies. I think all of us in neurology have become very accustomed to how you do that in multiple sclerosis, right? We've got MRI scans to be used to monitor therapy, maybe NFL is going to be an appropriate assay there as well. But, you know, there we've all had the experience of a chronic disease and seeing how well your therapy is doing, changing therapy if it fails. So, we're absolutely going to need those things in in Alzheimer's disease and other neurodegenerative diseases, but it's a little early for us to be sure exactly what the right measures are to make those important decisions. Dr Weathers: And a lot more work to be done for sure. As I mentioned, this is a topic of such great interest and I know, you know, certainly most of our listeners are neurologists or people in our world, medical students and trainees. I know I have one regular nonneurologist listener, my father. He really gets a kick out of listening to my interviews. Even though he is a retired sales manager from IBM and most of the time the topics of discussion are pretty different from his usual favorite podcasts. But this one he will be particularly interested in and I'm sure I will get a list of questions about, particularly because my grandfather unfortunately had Alzheimer's disease. So, I'm sure one of his questions will be about the use of these biomarkers in asymptomatic patients. How do you counsel family members of patients when they inquire about the use of biomarkers for that youth case? What is their utility in presymptomatic testing? Dr Quinn: We know from studies like the Alzheimer's disease neuroimaging initiative and other biomarker studies that some of these markers will be sensitive to pathology. Even in asymptomatic people, that pathology appears long before people develop symptoms. Despite that, I don't recommend that asymptomatic people get any of the testing right now because we do not have evidence that early intervention at the completely asymptomatic stage is valuable. And those clinical trials are underway. There are trials underway right now for people who don't even meet the memory deficit required to have a diagnosis of mild cognitive impairment, people who are entirely cognitively intact, but who on one biomarker study or another have evidence of pathology burden. And the interventions are being started early. And in a few years, we'll know the answer to that. Right now, for somebody to find out that they have pathology without any ability to act on it, I think is not valuable. So, I discourage people from pursuing that.  Dr Weathers: And that is really important guidance. Thank you. I know you have, as you mentioned, a beginning in a really diverse neurologic background with expertise, as you said, not only in dementia, but also in Parkinson's disease. And you didn't even mention this, but I know expertise in stroke as well, but your research has been primarily in Alzheimer's. What drew you to dementia and to this specific the aspect of it? How did you become an expert in biomarkers?  Dr Quinn: Well, I'll start with the dementia part. So, you know, I was always just interested intuitively in trying to understand how, you know, the brain mediates the mind. So as an undergraduate, I got started working in a lab that was working on the cholinergic system in the brain, which was still being sorted out at that time. It is important in Alzheimer's disease, but it was really where the focus was. And that's what got me interested in Alzheimer's disease, which incidentally is what got Alzheimer interested in Alzheimer's disease. You know, he was very interested in trying to find the biological footprints of all these different neurological and psychiatric diseases. And he usually came up empty-handed until he came across the patient with Alzheimer's disease where there were actual footprints in the brain that he thought was pointing towards what was going on. And we're still wondering about that a hundred years later, I guess that's how I got interested in dementia and Alzheimer's disease. I think I have always spent part of my time as a clinician. I think that's what got me interested in biomarkers, that this problem has always been there that, you know, we've got quite, you know, research criteria for making diagnosis and all that sort of thing. But we've really needed some biological evidence to help us firm this up even before the availability of the therapies. And that's what got me interested in- I'm making another point. I thought that computer research biomarkers are going to help point me towards the causes of the disease, and unfortunately that part hasn't entirely panned out. We've got some research in that area on micro-RNA biomarkers that maybe will bear some fruit down the road, but that's been a tougher, tougher nut to crack. Dr Weathers: But it's so incredibly important work. Well, this has been wonderful. I really enjoyed our conversation, and I always like to end on a hopeful note. What developments in the biomarker space are coming on the horizon are you most excited about? Dr Quinn: I'm hoping that these biomarkers that allow us to evaluate disease efficacy, blood biomarkers that don't require extraspinal taps and that sort of thing. I hope that all comes to pass. And I do think that there is a lot of research underway looking at biomarkers in a novel way that I think could help point us to new targets for therapy, things that you and I haven't even thought of yet. Those are the two things. I guess you asked me for one, I gave you two.  Dr Weathers: Oh I think very fair. I agree. Both of those would certainly be wonderful and, and I'm excited as well. Well, thank you, Dr Quinn, for taking the time to speak with me this evening.  Dr Quinn: A pleasure. Thank you for having me. Thank you for inviting me to do the piece. It was really a great experience.   Dr Weathers: Again, today I've been interviewing Dr Joseph Quinn, who's written with Doctor Nora Gray on fluid biomarkers and dementia diagnosis. This article appears in the December 2024 Continuum issue on Dementia. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, associate editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/AudioCME. Thank you for listening to Continuum Audio.

It's here, folks, the FINAL TSV Roundup of 2024! Your host Fred Bird reflects on the tremendous conservation policy developments the CSF team oversaw in 2024, including the passage of the Good Samaritan Remediation of Abandoned Hard Rock Mines Act, the expansion of crossbow hunting opportunities, and the introduction of hunter education programs in schools. He also discusses anticipated legislative changes regarding firearm regulations in Washington and highlights successes in the Mid-Atlantic region, such as the continued use of lead ammunition and the ability of the Fish and Boat Commission to set license fees.    Takeaways Year-End Review: Fred highlights ongoing legislative efforts in conservation policy. Despite setbacks, there is optimism for future legislative initiatives. The Good Samaritan Remediation Act: The Good Samaritan remediation act aims to clean up abandoned mines and their down stream waters. Hunter Education In Schools: Hunter education programs in schools are gaining bipartisan support.   Get the FREE Sportsmen's Voice e-publication in your inbox every Monday: www.congressionalsportsmen.org/newsletter

Today’s episode is with Dr. Jacqueline Chan, a holistic medicine physician at the Marin Natural Medicine Clinic. She holds an osteopathic medical degree from Ohio University and completed her Family Practice Residency in 1997. Dr. Chan is board certified in integrative holistic medicine and focuses on comprehensive health, addressing physical, emotional, and subtle energy aspects. She employs various treatments, including functional lab testing, orthomolecular substances, herbal remedies, IV nutrient therapy, and osteopathic cranio-sacral therapy. Dr. Chan emphasizes the importance of compassion, presence, and clinical knowledge in healing​ (Marin Natural Medicine Clinic)​. We talk about the following and so much more: ✅ Pivotal moments in your life that led you to focus on creating and teaching the class “Growing the Mystical Brain”✅ The latest understanding of the cerebral spinal fluid (CSF) and its potential connections to broader cosmic principles?✅ What exactly is medical intuition?✅ Why she has been called “The Physician Mystic”✅ What the bio-field is and how can you see it?✅ What is the 8th chakra? If you’d like to join the waitlist for my next coaching program, sign up @ www.InnerKnowingSchool.com Please tag us and tell us what you loved! You can follow @Gateways_To_Awakening on Instagram or Facebook if you’d like to stay connected.

In this episode of the Experience Miracles podcast, Dr. Tony Ebel interviews Dr. Bradley Campbell, a physician who reaches millions daily with educational content while maintaining a busy integrated clinic in Chicago's North Shore. They discuss the importance of nervous system health, adrenal fatigue, and holistic healing approaches. Dr. Campbell shares his personal journey into chiropractic care after a childhood injury, and both doctors explore how choosing the right doctor addressing nervous system dysfunction is crucial for healing chronic conditions (and experiencing miracles).[00:01:00] - Introduction of Dr. Bradley CampbellTen medical degrees and an integrated clinic in North ShoreImpact through content creation and patient care[00:05:00] - The Importance of Having a GuideFinding the right healthcare mentorBalance between self-healing and professional guidance[00:10:00] - Dr. Campbell's Personal StoryChildhood head injury and post-concussion syndromeTransformative experience with chiropractic care[00:13:00] - Understanding SubluxationDefinition of neurological interferenceTypes: Physical, emotional, chemicalImpact on CSF and brain function[00:16:00] - Case Study ExamplePatient with parasitic infectionNervous system's role in healing[00:22:00] - Adrenal Fatigue ExplainedThe four S's: Salt, Sex, Sugar, StressUnderstanding adrenal functionHormone regulation and balance[00:29:00] - Creativity and HealingPassion's role in healthDocumenting vs. creating contentBuilding authentic experience[00:37:00] - HRV (Heart Rate Variability)Stress testing and measurementTechnology in practiceConnection to healing and recovery[00:47:00] - Oliver's StoryHypoxic brain injury recoveryECMO treatmentAthletic achievements post-recovery[00:51:00] - Future DirectionsOnline membership developmentBook on weight lossReaching millions with health educationFollow Dr. Campbell on on Instagram @drbradleycampbell Join his membership community, details are linked hereRead his book "Do I have Adrenal Fatigue?" linked hereEngage with the Dr. Campbell Podcast linked here-- Follow us on Socials: Instagram: @pxdocs Facebook: Dr. Tony Ebel & The PX Docs Network Youtube: The PX Docs For more information, visit PXDocs.com to read informative articles about the power of Neurologically-Focused Chiropractic Care. To watch Dr. Tony's 30 min Perfect Storm Webinar: Click Here Find a PX Doc Office near me: PX DOCS Directory Subscribe, share, and stay tuned for more incredible episodes unpacking the power of Nervous System focused care for children!